Ricci F, Parravano M, Regine F, Sciamanna M, Tedeschi M, Missiroli F, Varano M
Ophthalmology Department, University of Rome Tor Vergata, Rome, Italy.
Ophthalmology Department, Fondazione G.B. Bietti-IRCCS, Rome, Italy.
Eye (Lond). 2016 Aug;30(8):1077-83. doi: 10.1038/eye.2016.95. Epub 2016 May 27.
PurposeTo evaluate the effects of aflibercept administered according to a pro re nata (PRN) or Fixed Regimen to patients with neovascular AMD and persistent intraretinal/subretinal fluid (IRF/SRF) despite three consecutive ranibizumab injections.MethodsPatients were switched to aflibercept injection (IVA) administered according to a PRN or to a fixed regimen for 1 year in two different retina centers. At baseline each patient underwent a complete ophthalmologic evaluation, including best-corrected visual acuity assessment (BCVA ETDRS chart), fluorescein, and indocyanine green angiography and OCT.ResultsEach group included 36 eyes. After 1 year the PRN group showed BCVA stabilization (63 vs 60 letters, P=0.33), whereas fixed regimen group showed significant BCVA improvement (68 vs 71, P=0.008). The median central retinal thickness decreased by 94 μm in the PRN (P=0.002) and by 148 μm in the fixed regimen group (P≤0.001). Complete IRF/SRF reabsorption was found in 58% of eyes in the PRN and in 42% of eyes in the fixed regimen group. At 1-year visit, the percentage of eyes with pigment epithelium detachment did not significantly decrease, but a height reduction was recorded in both groups. The median number of IVA was 3.5 in the PRN and 7 in the fixed regimen group.ConclusionThe switch to aflibercept with both treatment strategies enabled improvement in morphological parameters and stabilization of visual acuity. BCVA improvement and reduction in vision loss with reduction in retinal thickness, fluid and PED height was achieved with the fixed regimen in previously treated nAMD after 1 year.
目的
评估阿柏西普按按需（PRN）或固定方案给药对尽管连续注射三次雷珠单抗但仍患有新生血管性年龄相关性黄斑变性（nAMD）和持续性视网膜内/视网膜下液（IRF/SRF）的患者的效果。
方法
在两个不同的视网膜中心，患者被转换为按PRN或固定方案注射阿柏西普（玻璃体内注射），为期1年。基线时，每位患者均接受了全面的眼科评估，包括最佳矫正视力评估（BCVA ETDRS视力表）、荧光素和吲哚菁绿血管造影以及光学相干断层扫描（OCT）。
结果
每组包括36只眼。1年后，PRN组的BCVA稳定（63对60字母，P = 0.33），而固定方案组的BCVA有显著改善（68对71，P = 0.008）。PRN组的视网膜中央厚度中位数下降了94μm（P = 0.002），固定方案组下降了148μm（P≤0.001）。PRN组58%的眼内IRF/SRF完全吸收，固定方案组为42%。在1年随访时，色素上皮脱离的眼的百分比没有显著下降，但两组均记录到高度降低。PRN组玻璃体内注射阿柏西普的中位数为3.5次，固定方案组为7次。
结论
两种治疗策略转换为阿柏西普均可改善形态学参数并稳定视力。在先前接受治疗的nAMD患者中，固定方案在1年后实现了BCVA改善、视力丧失减少以及视网膜厚度、液体和PED高度降低。
