Azuma Keiko, Obata Ryo, Nomura Yoko, Tan Xue, Takahashi Hidenori, Yanagi Yasuo
*Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan; †Department of Ophthalmology, Jichi Medical University, Tochigi, Japan; ‡Singapore National Eye Centre, Singapore; §Singapore Eye Research Institute, Singapore; and ¶Duke-NUS (National University of Singapore) Graduate Medical School, Singapore.
Retina. 2016 Nov;36(11):2158-2165. doi: 10.1097/IAE.0000000000001047.
The aim of this study was to study the angiopathic findings of ranibizumab-resistant polypoidal choroidal vasculopathy after switching to a treat-and-extend regimen with intravitreal aflibercept.
The authors retrospectively reviewed 17 eyes of 17 Japanese patients with polypoidal choroidal vasculopathy (10 men and 7 women, age: 73.8 ± 7.4 years) who were treated with intravitreal aflibercept (2 mg/0.05 mL) injections from February 2013 to August 2014 at Tokyo University Hospital. All patients had switched to aflibercept because their polypoidal choroidal vasculopathy had been refractory to ranibizumab.
The mean logMAR best-corrected visual acuity at baseline and after 12 months of therapy was 0.30 ± 0.29 (Snellen equivalent: 20/40) and 0.17 ± 0.26 (20/30) (paired t-test P < 0.001). Visual acuity remained stable in 5 cases (29%), deteriorated in 3 (18%), and improved in 9 (53%). Branching vascular networks persisted in all 17 eyes but shrank in 15 (88%). The mean lesion diameter was 3329 ± 1261 μm at baseline and 3180 ± 1247 μm after 12 months (P = 0.0002).
A treat-and-extend regimen with intravitreal aflibercept for ranibizumab-resistant patients resulted in branching vascular network shrinkage over a 1-year period.
本研究旨在探讨在改用玻璃体内阿柏西普治疗并延长方案后，对雷珠单抗耐药的息肉状脉络膜血管病变的血管病变表现。
作者回顾性分析了2013年2月至2014年8月在东京大学医院接受玻璃体内阿柏西普（2mg/0.05mL）注射治疗的17例日本息肉状脉络膜血管病变患者的17只眼（10例男性和7例女性，年龄：73.8±7.4岁）。所有患者因息肉状脉络膜血管病变对雷珠单抗耐药而改用阿柏西普。
基线时及治疗12个月后的平均logMAR最佳矫正视力分别为0.30±0.29（Snellen视力表等效值：20/40）和0.17±0.26（20/30）（配对t检验P<0.001）。5例（29%）患者视力保持稳定，3例（18%）患者视力恶化，9例（53%）患者视力改善。所有17只眼中均存在分支血管网，但15只眼（88%）的分支血管网缩小。基线时平均病变直径为3329±1261μm，12个月后为3180±1247μm（P=0.0002）。
对于雷珠单抗耐药的患者，采用玻璃体内阿柏西普治疗并延长方案可在1年内导致分支血管网缩小。
