年龄相关性黄斑变性治疗试验（CATT）中视网膜血管瘤样增生患者的治疗结果
Outcomes in Eyes with Retinal Angiomatous Proliferation in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).
作者信息
Daniel Ebenezer, Shaffer James, Ying Gui-shuang, Grunwald Juan E, Martin Daniel F, Jaffe Glenn J, Maguire Maureen G
机构信息
Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Ophthalmology. 2016 Mar;123(3):609-16. doi: 10.1016/j.ophtha.2015.10.034. Epub 2015 Dec 8.
PURPOSE
To compare baseline characteristics, visual acuity (VA), and morphologic outcomes between eyes with retinal angiomatous proliferation (RAP) and all other eyes among patients with neovascular age-related macular degeneration (NVAMD) treated with anti-vascular endothelial growth factor (VEGF) drugs.
DESIGN
Prospective cohort study within the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).
PARTICIPANTS
Patients with NVAMD.
METHODS
Reading center staff evaluated digital color fundus photographs, fluorescein angiography (FA) images, and optical coherence tomography (OCT) scans of eyes with NVAMD treated with either ranibizumab or bevacizumab over a 2-year period. Retinal angiomatous proliferation was identified by the intense intra-retinal leakage of fluorescein in combination with other associated features.
MAIN OUTCOME MEASURES
Visual acuity; fluorescein leakage; scar; geographic atrophy (GA) on FA; retinal thickness, fluid, and subretinal hyperreflective material (SHRM) on OCT; and the number of intravitreal anti-VEGF injections at 1 and 2 years.
RESULTS
Retinal angiomatous proliferation was present in 126 of 1183 (10.7%) study eyes at baseline. Mean VA improvement from baseline was greater (10.6 vs. 6.9 letters; P = 0.01) at 1 year, but similar at 2 years (7.8 vs. 6.2 letters; P = 0.34). At 1 year, eyes with RAP were more likely to have no fluid (46% vs. 26%; P < 0.001) on OCT, no leakage on FA (61% vs. 50%; P = 0.03), and greater reduction in foveal thickness (-240 μm vs. -161 μm; P < 0.001). They were more likely to demonstrate GA (24% vs. 15%; P = 0.01) and less likely to have scarring (17% vs. 36%; P < 0.001) or SHRM (36% vs. 48%; P = 0.01). These results were similar at 2 years. The mean change in lesion size at 1 year differed (-0.27 DA vs. 0.27 DA; P = 0.02), but was similar at 2 years (0.49 DA vs. 0.79 DA; P = 0.26). Among eyes treated PRN, eyes with RAP received a lower mean number of injections in year 1 (6.1 vs. 7.4; P = 0.003) and year 2 (5.4 vs. 6.6; P = 0.025).
CONCLUSIONS
At both 1 and 2 years after initiation of anti-VEGF treatment in CATT, eyes with RAP were less likely to have fluid, FA leakage, scar, and SHRM and more likely to have GA than eyes without RAP. Mean improvement in VA was similar at 2 years.
目的
比较接受抗血管内皮生长因子（VEGF）药物治疗的新生血管性年龄相关性黄斑变性（NVAMD）患者中，视网膜血管瘤样增生（RAP）患眼与所有其他患眼的基线特征、视力（VA）和形态学转归。
设计
年龄相关性黄斑变性治疗试验比较（CATT）中的前瞻性队列研究。
参与者
NVAMD患者。
方法
阅读中心工作人员评估了在2年期间接受雷珠单抗或贝伐单抗治疗的NVAMD患眼的数字彩色眼底照片、荧光素血管造影（FA）图像和光学相干断层扫描（OCT）。视网膜血管瘤样增生通过荧光素在视网膜内的强烈渗漏及其他相关特征来识别。
主要观察指标
视力；荧光素渗漏；瘢痕；FA上的地图样萎缩（GA）；OCT上的视网膜厚度、液体和视网膜下高反射物质（SHRM）；以及1年和2年时玻璃体内抗VEGF注射次数。
结果
在基线时，1183只研究眼中有126只（10.7%）存在视网膜血管瘤样增生。1年时，从基线开始的平均视力改善更大（10.6对6.9个字母；P = 0.01），但2年时相似（7.8对6.2个字母；P = 0.34）。1年时，RAP患眼在OCT上更可能没有液体（46%对26%；P < 0.001），在FA上没有渗漏（61%对50%；P = 0.03），且黄斑厚度降低更大（-240μm对-161μm；P < 0.001）。它们更可能出现GA（24%对15%；P = 0.01），而出现瘢痕（17%对36%；P < 0.001）或SHRM（36%对48%；P = 0.01）的可能性较小。这些结果在2年时相似。1年时病变大小的平均变化不同（-0.27视盘面积对0.27视盘面积；P = 0.02），但2年时相似（0.49视盘面积对0.79视盘面积；P = 0.26）。在按需治疗的患眼中，RAP患眼在第1年（6.1次对7.4次；P = 0.003）和第2年（5.4次对6.6次；P = 0.025）接受的平均注射次数较少。
结论
在CATT中抗VEGF治疗开始后的1年和2年时，与无RAP的患眼相比，RAP患眼出现液体、FA渗漏、瘢痕和SHRM的可能性较小，而出现GA的可能性较大。2年时平均视力改善相似。
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