Fassnacht-Riederle Heidi, Becker Matthias, Graf Nicole, Michels Stephan
Department of Ophthalmology, City Hospital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland.
Graefes Arch Clin Exp Ophthalmol. 2014 Nov;252(11):1705-9. doi: 10.1007/s00417-014-2589-3. Epub 2014 Mar 11.
Evaluation of three aflibercept injections at 4-week intervals in patients with neovascular AMD showing an "insufficient anatomic response" to prior anti-VEGF therapy with ranibizumab or bevacizumab.
The retrospective analysis included 96 eyes that had received at least three intravitreal 0.5 mg ranibizumab or 1.25 mg bevacizumab injections over a period of no more than 4 months prior to switching to aflibercept. In addition, the selected eyes had to have evidence of persisting or increasing sub- or intraretinal fluid, observed in optical coherence tomography (OCT). All patients received a loading dose of three intravitreal 2 mg aflibercept injections at 4-week intervals. Evaluation included central retinal thickness (CRT) and maximum pigment epithelium (PED) height measured by spectral domain OCT and best-corrected visual acuity (BCVA) prior to the switch of therapy and 4 weeks after the third aflibercept injection.
A significant reduction of mean CRT (-39 μm; p < 0.001) and maximum PED height (-46 μm; p < 0.001) as found 4 weeks after the third aflibercept injection. Eighty-two out of 96 eyes (85 %) had a PED just prior to switching to aflibercept. There was an improvement in BCVA of 1.9 letters 4 weeks after the last aflibercept injection; the vision gain, however, did not reach statistical significance (p = 0.061). The further analysis did not show any correlation of the change in CRT, maximum PED, and BCVA with the number of prior anti-VEGF treatments.
Retinal edema and PEDs regressed significantly after switching to aflibercept in patients insufficiently responding to prior therapy with ranibizumab or bevacizumab. No correlation could be found with regard to the number of prior treatments.
评估在接受雷珠单抗或贝伐单抗抗VEGF治疗后出现“解剖学反应不足”的新生血管性年龄相关性黄斑变性（AMD）患者中，每隔4周注射三次阿柏西普的疗效。
回顾性分析纳入了96只眼，这些眼在改用阿柏西普之前的不超过4个月内接受了至少三次玻璃体内注射0.5mg雷珠单抗或1.25mg贝伐单抗。此外，所选眼必须在光学相干断层扫描（OCT）中显示有持续性或增加的视网膜下或视网膜内液的证据。所有患者接受三次玻璃体内注射2mg阿柏西普的负荷剂量，间隔4周。评估包括在治疗转换前和第三次阿柏西普注射后4周通过光谱域OCT测量的中心视网膜厚度（CRT）和最大色素上皮（PED）高度，以及最佳矫正视力（BCVA）。
第三次阿柏西普注射后4周，平均CRT显著降低（-39μm；p<0.001），最大PED高度显著降低（-46μm；p<0.001）。96只眼中有82只眼（85%）在改用阿柏西普之前存在PED。最后一次阿柏西普注射后4周，BCVA提高了1.9个字母；然而，视力提高未达到统计学显著性（p=0.061）。进一步分析未显示CRT、最大PED和BCVA的变化与先前抗VEGF治疗的次数之间存在任何相关性。
对于先前使用雷珠单抗或贝伐单抗治疗反应不足的患者，改用阿柏西普后视网膜水肿和PEDs显著消退。未发现与先前治疗次数相关。
