Department of Ophthalmology, Glostrup Hospital, Glostrup, Denmark.
Am J Ophthalmol. 2013 Jul;156(1):116-124.e1. doi: 10.1016/j.ajo.2013.02.012. Epub 2013 May 8.
To assess baseline and follow-up characteristics of choroidal neovascularization (CNV) lesions in age-related macular degeneration in relation to the development of subfoveal subretinal fibrosis.
Retrospective, observational case series.
settings and study population: One hundred ninety-seven treatment-naïve eyes in 197 patients with CNV in age-related macular degeneration without subfoveal fibrosis at first presentation who were treated with ranibizumab in a pro re nata regimen. main outcome measure: Subfoveal fibrosis at the conclusion follow-up of 24 months or fewer.
The hazard ratio of any subfoveal fibrosis developing in eyes with predominantly classic CNV was 5.95 (95% confidence interval [CI], 3.25 to 10.90) compared with minimally classic and occult CNV, whereas the hazard ratio of fibrosis developing with foveal atrophy was 3.38 (95% CI, 1.47 to 7.81; mean follow-up, 1.80 years; 95% CI, 1.75 to 1.85 years). The hazard ratio of any fibrosis developing was 3.38 (95% CI, 1.10 to 10.38) in eyes with a baseline best-corrected visual acuity of 40 or worse using Early Treatment Diabetic Retinopathy Study letter scores, as compared with eyes with a baseline best-corrected visual acuity of 70 letters or more. An interval between diagnosis and treatment of 15 days or more was associated with a hazard ratio of any fibrosis developing of 2.24 (95% CI, 1.28 to 3.94) as compared with an interval of fewer than 15 days. Compared with eyes in which fibrosis did not develop, eyes in which prominent fibrosis or fibrosis developed with foveal atrophy lost 8.5 more Early Treatment Diabetic Retinopathy Study letters (95% CI, -1.0 to -15.9; P = .0242) and 10.3 more Early Treatment Diabetic Retinopathy Study letters (95% CI, -4.0 to -16.5; P = .0012), respectively.
The development of subfoveal fibrosis in neovascular age-related macular degeneration was associated with predominantly classic CNV and poorer visual acuity at first presentation, a longer interval between diagnosis and treatment, and approximately 2 lines of additional visual loss at the conclusion follow-up.
评估与中心凹下视网膜下纤维化发展相关的年龄相关性黄斑变性脉络膜新生血管（CNV）病变的基线和随访特征。
回顾性、观察性病例系列。
研究地点和研究人群：197 例年龄相关性黄斑变性 CNV 患者的 197 只未经治疗的眼，初次就诊时无中心凹下视网膜下纤维化，采用雷珠单抗按需治疗方案治疗。主要观察指标：24 个月或更短时间内出现中心凹下纤维化。
与最小程度经典型和隐匿型 CNV 相比，主要为经典型 CNV 的眼发生任何中心凹下纤维化的风险比为 5.95（95%置信区间[CI]，3.25 至 10.90），而伴有中心凹萎缩的纤维化发生风险比为 3.38（95%CI，1.47 至 7.81；平均随访时间为 1.80 年；95%CI，1.75 年至 1.85 年）。与基线最佳矫正视力为 70 个字母或更高的眼相比，基线最佳矫正视力为 40 个字母或更差的眼（采用早期糖尿病性视网膜病变研究字母评分）出现任何纤维化的风险比为 3.38（95%CI，1.10 至 10.38）。诊断和治疗之间的间隔为 15 天或更长时间与任何纤维化发生的风险比为 2.24（95%CI，1.28 至 3.94）相比，间隔少于 15 天。与未发生纤维化的眼相比，发生显著纤维化或伴有中心凹萎缩的纤维化的眼分别丧失 8.5 个早期糖尿病性视网膜病变研究字母（95%CI，-1.0 至-15.9；P=.0242）和 10.3 个早期糖尿病性视网膜病变研究字母（95%CI，-4.0 至-16.5；P=.0012）。
新生血管性年龄相关性黄斑变性中中心凹下纤维化的发展与主要为经典型 CNV 以及初次就诊时视力较差、诊断和治疗之间的时间间隔较长以及在随访结束时视力损失约 2 行相关。
