Ladaique M, Dirani A, Ambresin A
Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Medical Retina Unit, Lausanne, Switzerland.
Klin Monbl Augenheilkd. 2015 Apr;232(4):542-7. doi: 10.1055/s-0035-1545817. Epub 2015 Apr 22.
The purpose of this contribution is to report our functional results on the efficacy of intravitreal ranibizumab for submacular choroidal neovessels (CNV) in high myopia, and to compare the roles of optical coherence tomography (OCT), fluorescein angiography and visual acuity changes in the treatment decision prior to each injection.
This is a retrospective study performed in Jules Gonin Eye Hospital. It included all patients with myopic CNV treated with intravitreal ranibizumab injections with a minimum follow-up of 24 months. After an induction dosing from 1 to 3 injections, the follow-up was based on a pro re nata regimen. Ophthalmic evaluation, best corrected visual acuity, and OCT were done at each visit, and fluorescein angiography at baseline and if neovascular activity was suspected. Retreatment criteria included metamorphopsia, visual loss of ≥5 ETDRS letters, any fluid on OCT and/or leakage on fluorescein angiography.
24 eyes were included in the study. Mean follow-up was 49 months. Mean visual acuity improved significantly from 62.8±13.8 letters at baseline to 72.8±12.9 letters at last follow-up visit (p=0.001). The mean number of injections was 2.2 in the first year and below 1 for the following years. The sensitivities of fluorescein angiography, SD OCT, and visual acuity loss≥5 letters were 62.6%, 51.4%, and 40%, respectively. The fluorescein angiography showed a significantly higher sensitivity in treatment decision than OCT (p=0.007).
Our study has shown that ranibizumab injections provide a significant long-term visual benefit in myopic CNV with a small number of injections. Fluorescein angiography has a preponderant role in the treatment decision of active myopic CNV.
本研究旨在报告玻璃体内注射雷珠单抗治疗高度近视性黄斑下脉络膜新生血管（CNV）的功能结果，并比较光学相干断层扫描（OCT）、荧光素血管造影和视力变化在每次注射前治疗决策中的作用。
这是一项在朱尔斯·戈宁眼科医院进行的回顾性研究。纳入所有接受玻璃体内注射雷珠单抗治疗的近视性CNV患者，且至少随访24个月。在进行1至3次诱导注射后，随访采用按需治疗方案。每次就诊时进行眼科评估、最佳矫正视力和OCT检查，基线时及怀疑有新生血管活动时进行荧光素血管造影。再次治疗标准包括视物变形、视力下降≥5个ETDRS字母、OCT上有任何液性暗区和/或荧光素血管造影有渗漏。
本研究共纳入24只眼。平均随访49个月。平均视力从基线时的62.8±13.8字母显著提高至最后一次随访时的72.8±12.9字母（p = 0.001）。第一年平均注射次数为2.2次，随后几年低于1次。荧光素血管造影、SD OCT和视力下降≥5个字母的敏感度分别为62.6%、51.4%和40%。荧光素血管造影在治疗决策中的敏感度显著高于OCT（p = 0.007）。
我们的研究表明，注射雷珠单抗可为近视性CNV患者带来显著的长期视力益处，且注射次数较少。荧光素血管造影在活动性近视性CNV的治疗决策中起主要作用。
