The Ludwig Boltzmann Institute for Retinology and Biomicroscopic Laser Surgery, Vienna, Austria.
Br J Ophthalmol. 2013 Nov;97(11):1443-6. doi: 10.1136/bjophthalmol-2013-303513. Epub 2013 Aug 21.
Most of the publications on modern therapy of neovascular age-related macular degeneration focus on the effect of the treatment. The purpose of this study is to determine the frequency of non-responders to anti-vascular endothelial growth factor (anti-VEGF) treatment and find possible reasons for their failure to respond.
The records of patients treated until the end of 2008 the first time with either bevacizumab or ranibizumab were reviewed. Based on the availability of measurable results and according to prior publications showing the effect of the therapy, loss of three lines of distance acuity, increase of retinal thickness or lesion size were identified as indicators of non-responders. Two of these three signs had to be present.
334 eyes of 283 patients were included; 74.55% received bevacizumab and 25.45% received ranibizumab. Overall 14.37% of the eyes were identified as non-responders (14.06% in the bevacizumab group and 15.29% in the ranibizumab group). Baseline distance acuity and vitreo-retinal adhesions were significantly correlated with non-responders. Correlations with age, gender, lesion type, other morphologic features, and the kind of anti-VEGF agent failed to be significant. 10.4% of the non-responders showed a delayed but good response to anti-VEGF treatment.
About 15% did not sufficiently respond to anti-VEGF treatment. Vitreo-retinal adherences were the only ophthalmologic factor which could be identified to be significantly correlated with insufficient response.
大多数关于新生血管性年龄相关性黄斑变性的现代治疗的出版物都集中在治疗效果上。本研究的目的是确定抗血管内皮生长因子（抗-VEGF）治疗的无应答者的频率，并找到其无应答的可能原因。
回顾了 2008 年底前首次接受贝伐单抗或雷珠单抗治疗的患者的记录。根据可测量结果的可用性，并根据先前显示治疗效果的出版物，将视力丧失 3 行、视网膜厚度或病变大小增加确定为无应答者的指标。这三个迹象中必须有两个存在。
共纳入 283 例患者的 334 只眼；74.55%接受贝伐单抗治疗，25.45%接受雷珠单抗治疗。总体而言，有 14.37%的眼被确定为无应答者（贝伐单抗组为 14.06%，雷珠单抗组为 15.29%）。基线视力和玻璃体视网膜粘连与无应答者显著相关。与年龄、性别、病变类型、其他形态特征以及抗 VEGF 药物的相关性均无统计学意义。10.4%的无应答者对抗 VEGF 治疗有延迟但良好的反应。
约 15%的患者对抗 VEGF 治疗反应不足。玻璃体视网膜粘连是唯一可以确定与治疗反应不足显著相关的眼科因素。
