Ng Danny Siu-Chun, Kwok Alvin Kwan-Ho, Tong Justin Man-Kit, Chan Clement Wai-Nang, Li Walton Wai-Tat
Department of Ophthalmology & Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China.
Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, China.
Int J Ophthalmol. 2016 Mar 18;9(3):424-30. doi: 10.18240/ijo.2016.03.17. eCollection 2016.
To determine the outcome of non-investigational treatment with intravitreal bevacizumab (IVB) in neovascular age-related macular degeneration (AMD) patients.
Retrospective chart review of 81 eyes with neovascular AMD followed-up for at least 12mo and received 3-monthly loading IVB injections. Re-treat was based upon the individual clinician's judgment. Best-corrected visual acuity (BCVA) and optical coherence tomography measurements of central foveal thickness outcomes were evaluated at 12, 24mo.
Eighty-one eyes (of 75 patients) completed 12mo of follow-up and 44 eyes (of 41 patients) completed 24mo of follow-up. The mean baseline logMAR BCVA significantly improved from 0.94±0.69 to 0.85±0.68 at 12mo (P<0.001) and from 0.91±0.65 to 0.85±0.60 (P=0.004) at 24mo. The proportion of eyes that lost <15 logMAR letters at 12mo was 90.1% and at 24mo was 81.8%. IVB was effective in improving visual acuity in both treatment naïve and previous photodynamic therapy (PDT)-treated subgroups. Treatment naive patients required significantly fewer injections than patients with prior PDT. Multiple regression analysis identified that poorer baseline visual acuity was associated with greater improvement in visual acuity (P=0.015).
Fewer injections in clinical practice may result in suboptimal visual outcomes compared with clinical trials of IVB in neovascular AMD patients. Poor baseline visual acuity and prior PDT treatment may also improve vision after IVB. The safety and durability of effect was maintained at 24mo.
确定玻璃体内注射贝伐单抗(IVB)治疗新生血管性年龄相关性黄斑变性(AMD)患者的非研究性治疗效果。
对81例新生血管性AMD患者的眼睛进行回顾性病历审查,随访至少12个月,并接受每3个月一次的负荷IVB注射。再次治疗基于个体临床医生的判断。在12个月、24个月时评估最佳矫正视力(BCVA)和中央凹厚度的光学相干断层扫描测量结果。
75例患者的81只眼睛完成了12个月的随访,41例患者的44只眼睛完成了24个月的随访。平均基线logMAR BCVA在12个月时从0.94±0.69显著提高到0.85±0.68(P<0.001),在24个月时从0.91±0.65提高到0.85±0.60(P=0.004)。在12个月时视力下降<15个logMAR字母的眼睛比例为90.1%,在24个月时为81.8%。IVB在初治和既往接受过光动力疗法(PDT)治疗的亚组中均能有效提高视力。初治患者所需的注射次数明显少于既往接受过PDT治疗的患者。多元回归分析表明,较差的基线视力与视力改善程度较大相关(P=0.015)。
与IVB治疗新生血管性AMD患者的临床试验相比,临床实践中较少的注射次数可能导致视力结果不理想。较差的基线视力和既往PDT治疗也可能在IVB治疗后改善视力。在24个月时维持了疗效的安全性和持久性。