Waizel Maria, Rickmann Annekatrin, Blanke Björn R, Wolf Katharina, Kazerounian Sara, Szurman Peter
University Eye Hospital Basel, Centre for Ophthalmology, Basel - Switzerland.
Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar - Germany.
Eur J Ophthalmol. 2016 Aug 4;26(5):469-72. doi: 10.5301/ejo.5000781. Epub 2016 Apr 12.
To study the visual outcome and change in central macular thickness (CMT) in patients with neovascular age-related macular degeneration (AMD) who were previously treated with aflibercept (VEGF Trap-Eye, Eylea) and were subsequently switched to bevacizumab (Avastin).
In this observational analysis, 19 eyes initially treated with at least 3 injections of bevacizumab after initial treatment with at least 3 injections of aflibercept are reported. Outcome measures were Snellen visual acuity (best-corrected visual acuity (BCVA) and CMT measured by spectral-domain optical coherence tomography.
A total of 19 eyes initially treated with 6.5 ± 2.8 intravitreal injections of aflibercept were switched to 5.4 ± 3.2 injections of bevacizumab. Median BCVA decreased from 20/94 to 20/113 after aflibercept and increased slightly to 20/101 after bevacizumab (p = 0.84, Friedman test). Of all 19 eyes, 36.8% achieved gain in visual acuity of more than 1 line and 21.1% of more than 3 lines. The CMT decreased slightly from 433 ± 229 μm at baseline to 367 ± 198 μm after aflibercept treatment (p = 0.18, Wilcoxon test) and decreased statistically significantly to 335 ± 184 μm after bevacizumab treatment (p = 0.0065, Wilcoxon test).
Switching from aflibercept to bevacizumab treatment has an equivalent anatomical effect in eyes with neovascular AMD as switching from bevacizumab to aflibercept. Therefore, switching back to bevacizumab might represent a reasonable therapy strategy to overcome tachyphylaxis during long-term monotherapy with aflibercept.
研究曾接受阿柏西普（VEGF Trap-Eye，阿瓦斯汀）治疗，随后改用贝伐单抗（安维汀）的新生血管性年龄相关性黄斑变性（AMD）患者的视力转归及黄斑中心厚度（CMT）变化。
在这项观察性分析中，报告了19只眼，这些眼在最初接受至少3次阿柏西普注射治疗后，又接受了至少3次贝伐单抗注射。观察指标为Snellen视力（最佳矫正视力（BCVA））以及通过频域光学相干断层扫描测量的CMT。
最初接受平均6.5±2.8次玻璃体内阿柏西普注射治疗的19只眼中，改用平均5.4±3.2次贝伐单抗注射。阿柏西普治疗后BCVA中位数从20/94降至20/113，改用贝伐单抗后略有上升至20/101（Friedman检验，p = 0.84）。在所有19只眼中，36.8%的患眼视力提高超过1行，21.1%的患眼视力提高超过3行。CMT在基线时为433±229μm，阿柏西普治疗后略有下降至367±198μm（Wilcoxon检验，p = 0.18），贝伐单抗治疗后统计学上显著下降至335±184μm（Wilcoxon检验，p = 0.0065）。
从阿柏西普改用贝伐单抗治疗，在新生血管性AMD眼中与从贝伐单抗改用阿柏西普具有相同的解剖学效果。因此，改用贝伐单抗可能是一种合理的治疗策略，以克服长期单一使用阿柏西普治疗时出现的快速耐受现象。
