Wolfe Jeremy D, Shah Ankoor R, Yonekawa Yoshihiro, Al Faran Abdulrahman, Franklin Michael S, Abbey Ashkan M, Capone Antonio
Associated Retinal Consultants, Royal Oak, MI - USA.
Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, MI - USA.
Eur J Ophthalmol. 2016 Mar-Apr;26(2):168-73. doi: 10.5301/ejo.5000686. Epub 2015 Oct 1.
Current treatment paradigms for macular edema associated with retinal vein occlusions (RVO) often involve initial treatment with anti-vascular endothelial growth factor (VEGF) agents, then switching to intravitreal dexamethasone implant (IDI; Ozurdex, Allergan, Parsippany, NJ) for poor responders. However, many patients undergo multiple injections prior to being declared a nonresponder. We devised a method for prediction of poor anti-VEGF response after one injection, and show that these patients subsequently respond well to IDI.
This study is a retrospective consecutive interventional case series of patients with RVO receiving anti-VEGF agents that were switched to IDI. Patients were categorized as nonresponders to anti-VEGF agents (edema did not improve) or responders (edema improved, but switched to IDI for longer treatment duration). Receiver operating characteristics (ROC) curve analysis was used to determine cutoffs of reduction in central retinal thickness (CRT) to predict poor response to anti-VEGF treatment.
Twenty-three patients met inclusion criteria. There were 14 nonresponders and 9 responders. The ROC curve analysis found that the maximal sensitivity and specificity in correctly identifying responders to anti-VEGF therapy was those with >25% reduction in CRT 1 month after 1 anti-VEGF treatment (sensitivity 0.89, specificity 0.79, area under the curve 0.93). After IDI placement, anti-VEGF nonresponders showed significant improvement in visual acuity (VA) (p = 0.02) and CRT (p = 0.01).
In patients with macular edema secondary to RVOs, a reduction in CRT by ≤25%, 1 month after 1 anti-VEGF injection, is predictive of poor response to anti-VEGF treatment. These patients may benefit from earlier conversion to IDI treatment, which in our study, resulted in improved VA and CRT.
目前视网膜静脉阻塞（RVO）相关黄斑水肿的治疗模式通常包括先用抗血管内皮生长因子（VEGF）药物进行初始治疗，然后对于反应不佳者改用玻璃体内地塞米松植入物（IDI；奥瑞珠单抗，艾尔建公司，新泽西州帕西帕尼）。然而，许多患者在被判定为无反应者之前要接受多次注射。我们设计了一种方法来预测单次注射抗VEGF药物后的低反应情况，并表明这些患者随后对IDI反应良好。
本研究是一项回顾性连续干预病例系列研究，纳入接受抗VEGF药物治疗后改用IDI的RVO患者。患者被分为抗VEGF药物无反应者（水肿未改善）或反应者（水肿改善，但改用IDI以延长治疗时间）。采用受试者操作特征（ROC）曲线分析来确定中心视网膜厚度（CRT）降低的临界值，以预测对抗VEGF治疗的低反应。
23例患者符合纳入标准。其中14例为无反应者，9例为反应者。ROC曲线分析发现，正确识别抗VEGF治疗反应者的最大敏感性和特异性是在1次抗VEGF治疗后1个月CRT降低>25%的患者（敏感性0.89，特异性0.79，曲线下面积0.93）。植入IDI后，抗VEGF无反应者的视力（VA）（p = 0.02）和CRT（p = 0.01）有显著改善。
在继发于RVO的黄斑水肿患者中，1次抗VEGF注射后1个月CRT降低≤25%可预测对抗VEGF治疗的低反应。这些患者可能从早期改用IDI治疗中获益，在我们的研究中，这导致了VA和CRT的改善。
