Seibel Ira, Hager Annette, Duncker Tobias, Riechardt Aline I, Nürnberg Daniela, Klein Julian P, Rehak Matus, Joussen Antonia M
Department of Ophthalmology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Graefes Arch Clin Exp Ophthalmol. 2016 Apr;254(4):653-9. doi: 10.1007/s00417-015-3096-x. Epub 2015 Jul 7.
The purpose of this study was to describe the anatomical and functional outcome of vascular endothelial growth factor inhibitor (anti-VEGF) treatment in symptomatic peripheral exudative hemorrhagic chorioretinopathy (PEHCR) involving the macula.
Clinical records from patients seen between 2012 and 2013 at a single academic center were reviewed to identify PEHCR patients receiving anti-VEGF therapy due to disease-associated changes involving the macula. Affected eyes were either treated with consecutive intravitreal injections of anti-VEGF or vitrectomy combined with anti-VEGF followed by pro re nata injections.
The mean age of the patients was 76 years (range 70-89 years). In all nine eyes, visual acuity was reduced due to central subretinal fluid. On average, three anti-VEGF injections (range 2-5 injections) were required initially to achieve complete resolution of macular subretinal fluid. In three eyes, subretinal fluid reappeared after an average of 10 months (range 5-16 months), and an average of 2.5 anti-VEGF injections (range 2-3 injections) were necessary to attain complete resolution of macular subretinal fluid a second time. Median visual acuity at the visit before the first injection was 1.0 logMAR (range 2.1-0.4 logMAR) and increased to 0.8 logMAR (range 2-0.1 logMAR) at the last visit.
Results of this study show that for cases in which PEHCR becomes symptomatic due to macular involvement, anti-VEGF treatment may have drying potential. Although vision was improved in some patients, it remained limited in cases with long-term macular involvement, precluding any definitive functional conclusion. However, we believe that the use of anti-VEGF agents should be recommended in PEHCR that threatens the macula. Due to its often self-limiting course, peripheral lesions should be closely observed. Larger studies are needed in order to provide clear evidence of the efficacy of anti-VEGF therapy in PEHCR.
本研究旨在描述血管内皮生长因子抑制剂（抗VEGF）治疗累及黄斑的症状性周边渗出性出血性脉络膜视网膜病变（PEHCR）的解剖学和功能结局。
回顾了2012年至2013年在单一学术中心就诊的患者的临床记录，以确定因累及黄斑的疾病相关变化而接受抗VEGF治疗的PEHCR患者。受累眼睛要么接受连续玻璃体内注射抗VEGF，要么接受玻璃体切除术联合抗VEGF，随后按需注射。
患者的平均年龄为76岁（范围70 - 89岁）。在所有9只眼中，视力因黄斑下视网膜积液而下降。最初平均需要3次抗VEGF注射（范围2 - 5次注射）才能使黄斑下视网膜积液完全消退。在3只眼中，视网膜下积液在平均10个月（范围5 - 16个月）后再次出现，平均需要2.5次抗VEGF注射（范围2 - 3次注射）才能第二次使黄斑下视网膜积液完全消退。首次注射前就诊时的中位视力为1.0 logMAR（范围2.1 - 0.4 logMAR），最后一次就诊时增至0.8 logMAR（范围2 - 0.1 logMAR）。
本研究结果表明，对于因黄斑受累而使PEHCR出现症状的病例，抗VEGF治疗可能具有使积液消退的潜力。尽管一些患者的视力有所改善，但在长期黄斑受累的病例中视力改善仍然有限，无法得出任何明确的功能结论。然而，我们认为对于威胁黄斑的PEHCR应推荐使用抗VEGF药物。由于其病程通常具有自限性，周边病变应密切观察。需要进行更大规模的研究，以便为抗VEGF治疗在PEHCR中的疗效提供明确证据。
