Gerding H
Department of Ophthalmology, Pallas Kliniken, Olten, Switzerland (Director: Prof. Dr. Heinrich Gerding).
Klin Monbl Augenheilkd. 2015 Apr;232(4):560-3. doi: 10.1055/s-0035-1545775. Epub 2015 Apr 22.
It was the aim of this retrospective study to analyse the functional and anatomic efficacy of a conversion from ranibizumab to aflibercept treatment in eyes with exsudative age-related macular degeneration (AMD) with recently unsatisfactory response to a ranibizumab treatment.
MATERIAL, PATIENTS AND METHODS: 40 eyes of 37 patients (age: 80.6±7.7 years [mean±1 standard deviation (SD)] were included. The average visual acuity (VA) was 0.56±0.33 logMAR [mean±standard error (SE)] at the time of the first aflibercept injection. The eyes had received a mean of 21.5±11.7 (mean±SD) injections of ranibizumab within 3.15±1.79 (mean±SD) years. Follow-up covered 6 months in all patients. Before and after treatment and conversion of treatment, a PRN regimen with monthly visual acuity and OCT examinations was applied.
After conversion to aflibercept the mean gain of VA was 0.45±1.26 lines at month 1 (mean±SE, p=0.04), 0.26±1.60 at months 3 (p=0.067), and 0.65±1.77 (p=0.03) at month 6. Total OCT central foveal point thickness decreased from 417±215 µm (mean±1 SD) before the first injection of aflibercept to 299±139 (p<0.001), 325±174 at month 3 (p<0.001), and 321±150 µm at month 6 (p<0.001). The average number of aflibercept injections was 4.0±1.1 (mean±SD). At the end of follow up 61% of eyes had gained ≥1 line, 22%≥2 lines, and 12%≥ 3 lines. 10% had lost ≥1 line, 5%≥2 lines, and 2%≥3 lines.
The results of this case series show that conversion from ranibizumab to aflibercept can significantly reduce retinal thickness and improve visual acuity in patients with age-related macular degeneration with increasingly unsatisfactory response to long-term ranibizumab treatment.
本回顾性研究旨在分析在近期对雷珠单抗治疗反应不佳的渗出性年龄相关性黄斑变性（AMD）患者中，从雷珠单抗转换为阿柏西普治疗的功能和解剖学疗效。
材料、患者与方法：纳入37例患者的40只眼（年龄：80.6±7.7岁[平均值±1标准差（SD）]）。首次注射阿柏西普时的平均视力（VA）为0.56±0.33 logMAR[平均值±标准误（SE）]。这些眼睛在3.15±1.79年（平均值±SD）内平均接受了21.5±11.7次（平均值±SD）雷珠单抗注射。所有患者的随访期为6个月。在治疗前、治疗转换前后，采用按需治疗方案，每月进行视力和光学相干断层扫描（OCT）检查。
转换为阿柏西普治疗后，第1个月时VA的平均改善为0.45±1.26行（平均值±SE，p=0.04），第3个月时为0.26±1.60行（p=0.067），第6个月时为0.65±1.77行（p=0.03）。OCT中央凹总厚度从首次注射阿柏西普前的417±215μm（平均值±1 SD）降至299±139μm（p<0.001），第3个月时为325±174μm（p<0.001），第6个月时为321±150μm（p<0.001）。阿柏西普的平均注射次数为4.0±1.1次（平均值±SD）。随访结束时，61%的眼睛视力提高≥1行，22%提高≥2行，12%提高≥3行。10%的眼睛视力下降≥1行，5%下降≥2行，2%下降≥3行。
本病例系列结果表明，对于长期接受雷珠单抗治疗反应越来越差的年龄相关性黄斑变性患者，从雷珠单抗转换为阿柏西普可显著降低视网膜厚度并提高视力。
