Section of Vitreoretinal Disease and Surgery, Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, GA 30322, USA.
Am J Ophthalmol. 2013 Jul;156(1):23-28.e2. doi: 10.1016/j.ajo.2013.02.009. Epub 2013 May 8.
To report results of aflibercept therapy in eyes with neovascular age-related macular degeneration previously treated with bevacizumab, ranibizumab, or both.
Retrospective, interventional, noncomparative, consecutive case series.
Ninety-six eyes from 85 patients with neovascular age-related macular degeneration who previously had received bevacizumab, ranibizumab, or both were treated with aflibercept monthly for 3 months followed by a fourth injection within 2 months. Outcomes were determined 4 ± 1 months after the first aflibercept dose and included: proportion of patients gaining or losing 2 lines or more of best-corrected visual acuity, proportion remaining within a gain or loss of 1 line, mean change in logarithm of the minimal angle of resolution visual acuity, mean change in central foveal thickness, mean change in macular cube volume, and qualitative anatomic response as assessed by spectral-domain optical coherence tomography.
At baseline, 82 (85%) eyes had signs of active exudation despite a mean of 17 previous anti-vascular endothelial growth factor injections. At final visit, 82 (85%) remained stable within a gain or loss of 1 line, 7 (7%) gained 2 lines or more, and 7 (7%) lost 2 lines or more of best-corrected visual acuity. Mean logarithm of the minimal angle of resolution visual acuity showed minimal change 0.02 (range, -0.46 to 0.70; P = .14). Mean central foveal thickness decreased -18 μm (range, -242 to 198 μm; P = .06). Mean macular volume decreased -0.27 mm(3) (95% confidence interval, -0.4 to -0.1 mm(3); P = .004). On qualitative analysis, 4 (5%) eyes had complete resolution of exudative fluid, 40 (49%) showed partial resolution, 26 (32%) remained unchanged, and 12 (14%) showed worsened exudative fluid.
Aflibercept seems to be an effective alternative for neovascular age-related macular degeneration patients previously treated with bevacizumab, ranibizumab, or both at 4 months of follow-up. Most treated eyes demonstrated stable visual acuity and anatomic improvements by spectral-domain optical coherence tomography.
报告既往接受贝伐单抗、雷珠单抗或两者联合治疗的新生血管性年龄相关性黄斑变性患者接受阿柏西普治疗的结果。
回顾性、干预性、非对照、连续病例系列研究。
96 只眼来自 85 例新生血管性年龄相关性黄斑变性患者，既往接受过贝伐单抗、雷珠单抗或两者联合治疗，每月接受阿柏西普治疗 3 个月，之后在 2 个月内进行第四次注射。在首次接受阿柏西普治疗后 4 ± 1 个月确定治疗结果，包括：视力提高或降低 2 行或以上的患者比例、视力稳定在 1 行内的患者比例、最小分辨角对数视力的平均变化、中央视网膜厚度的平均变化、黄斑容积的平均变化，以及通过频域光学相干断层扫描评估的定性解剖反应。
基线时，尽管有 17 次抗血管内皮生长因子注射，但 82（85%）只眼仍有活动性渗出的迹象。在最后一次随访时，82（85%）只眼视力稳定在 1 行内，7（7%）只眼视力提高 2 行或以上，7（7%）只眼视力降低 2 行或以上。最小分辨角对数视力的平均对数仅略有变化，为 0.02（范围：-0.46 至 0.70；P =.14）。中央视网膜厚度平均降低了-18μm（范围：-242 至 198μm；P =.06）。黄斑容积平均减少了-0.27mm（3）（95%置信区间：-0.4 至-0.1mm（3）；P =.004）。定性分析显示，4（5%）只眼的渗出液完全消退，40（49%）只眼部分消退，26（32%）只眼无变化，12（14%）只眼渗出液恶化。
在 4 个月的随访中，阿柏西普似乎是既往接受贝伐单抗、雷珠单抗或两者联合治疗的新生血管性年龄相关性黄斑变性患者的有效替代治疗方法。大多数接受治疗的眼睛通过频域光学相干断层扫描显示出稳定的视力和解剖学改善。
