Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
Am J Ophthalmol. 2013 Jul;156(1):29-35.e2. doi: 10.1016/j.ajo.2013.03.030. Epub 2013 May 10.
To explore the visual and anatomic outcomes of patients with refractory or recurrent neovascular age-related macular degeneration (AMD) who were converted from bevacizumab and/or ranibizumab to aflibercept.
Two-center, retrospective chart review.
Treatment history, visual acuity (VA), and central macular thickness (CMT) on spectral-domain optical coherence tomography were collected. Patients were divided into "refractory" (persistent exudation despite monthly injections) or "recurrent" (exudation suppressed, but requiring frequent injections).
One hundred and two eyes of 94 patients were included; 68 were refractory and 34 were recurrent. Eyes received a mean of 20.4 prior bevacizumab/ranibizumab injections and a mean of 3.8 aflibercept injections. Mean follow-up was 18 weeks. Mean VA was 20/50-1 before conversion, 20/50-2 after 1 aflibercept injection (P = .723), and 20/50+2 after the final injection (P = .253). Subgroup analysis of refractory and recurrent cases also showed stable VA. Of the refractory cases, mean CMT had improved after 1 injection (P < .001) and the final injection (P < .001). Intraretinal (P < .001) and subretinal (P < .001) fluid decreased after 1 injection, and the mean injection interval was extended from 5.2 to 6.2 weeks (P = .003). Of the recurrent cases, mean CMT improved after 1 injection (P < .001) and the final injection (P < .001). Intraretinal (P = .003) and subretinal (P = .046) fluid decreased after 1 injection, and the mean injection interval was extended from 7.2 to 9.5 weeks (P = .001).
Converting patients with chronic neovascular AMD to aflibercept results in stabilized vision and improved anatomic outcomes, while allowing injection intervals to be extended.
探讨将贝伐单抗和/或雷珠单抗治疗的难治性或复发性新生血管性年龄相关性黄斑变性（AMD）患者转换为阿柏西普的视力和解剖学结果。
两中心回顾性图表研究。
收集治疗史、视力（VA）和频域光学相干断层扫描的中心黄斑厚度（CMT）。患者分为“难治性”（尽管每月注射仍持续渗出）或“复发性”（渗出抑制，但需要频繁注射）。
共纳入 94 例患者的 102 只眼；68 只为难治性，34 只为复发性。这些眼平均接受了 20.4 次贝伐单抗/雷珠单抗注射和 3.8 次阿柏西普注射。平均随访 18 周。转换前平均 VA 为 20/50-1，注射 1 次阿柏西普后为 20/50-2（P=0.723），最后一次注射后为 20/50+2（P=0.253）。难治性和复发性病例的亚组分析也显示出稳定的 VA。在难治性病例中，1 次注射后（P<0.001）和最后一次注射后（P<0.001）CMT 均有所改善。视网膜内（P<0.001）和视网膜下（P<0.001）积液在 1 次注射后减少，平均注射间隔从 5.2 周延长至 6.2 周（P=0.003）。在复发性病例中，1 次注射后（P<0.001）和最后一次注射后（P<0.001）CMT 均有所改善。视网膜内（P=0.003）和视网膜下（P=0.046）积液在 1 次注射后减少，平均注射间隔从 7.2 周延长至 9.5 周（P=0.001）。
将慢性新生血管性 AMD 患者转换为阿柏西普可稳定视力并改善解剖学结果，同时延长注射间隔。
