Kim Moosang, Kim Eung Suk, Seo Kyung Hoon, Yu Seung-Young, Kwak Hyung-Woo
Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, Korea.
Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea.
Indian J Ophthalmol. 2016 Jun;64(6):427-33. doi: 10.4103/0301-4738.187659.
The study aimed to investigate the quantitative changes of retinal pigment epithelial (RPE) atrophy during a 24-month follow-up period of anti-vascular endothelial growth factor (VEGF) for exudative age-related macular degeneration (AMD).
This is a retrospective study. Sixty-five eyes of 62 consecutive patients with naοve exudative AMD who had received treatment with anti-VEGF therapy and followed for more 24 months were enrolled. All patients received three initial monthly injections of anti-VEGF (ranibizumab or bevacizumab), followed by pro re nata or treat-and-extend protocol. Color fundus image, optical coherence tomography, and fundus autofluorescence were evaluated for RPE atrophy. Multiple regression analysis was performed to investigate the predictive factors found during univariate analysis to identify an association with increased RPE atrophic areas.
The mean number of anti-VEGF treatments was 9.18. RPE atrophic area was 1.293 ± 1.298 mm 2 at baseline and enlarged to 2.394 ± 1.940 mm 2 after 24 months, which differed significantly (P = 0.001). Multiple regression analysis revealed that larger areas of RPE atrophy at month 4 and larger numbers of anti-VEGF treatments were associated with increased RPE atrophic areas.
RPE atrophy progresses in eyes with exudative AMD during anti-VEGF treatment. Larger areas of RPE atrophy at month 4 and larger numbers of anti-VEGF injections were associated with an increased risk of progression of RPE atrophy the following treatment. These findings may be useful to clinicians using intravitreal anti-VEGF for the treatment of exudative AMD, both for selecting an appropriate treatment plan and for predicting the progression of RPE atrophy.
本研究旨在调查抗血管内皮生长因子（VEGF）治疗渗出性年龄相关性黄斑变性（AMD）24个月随访期间视网膜色素上皮（RPE）萎缩的定量变化。
这是一项回顾性研究。纳入62例初治渗出性AMD患者的65只眼，这些患者接受了抗VEGF治疗并随访超过24个月。所有患者最初每月接受3次抗VEGF（雷珠单抗或贝伐单抗）注射，随后根据需要或采用治疗并延长方案。对彩色眼底图像、光学相干断层扫描和眼底自发荧光进行RPE萎缩评估。进行多元回归分析以研究单因素分析中发现的预测因素，以确定与RPE萎缩面积增加的关联。
抗VEGF治疗的平均次数为9.18次。基线时RPE萎缩面积为1.293±1.298mm²，24个月后扩大至2.394±1.940mm²，差异有统计学意义（P = 0.001）。多元回归分析显示，第4个月时RPE萎缩面积较大和抗VEGF治疗次数较多与RPE萎缩面积增加有关。
抗VEGF治疗期间，渗出性AMD患者的RPE萎缩会进展。第4个月时RPE萎缩面积较大和抗VEGF注射次数较多与后续治疗中RPE萎缩进展风险增加有关。这些发现可能有助于使用玻璃体内抗VEGF治疗渗出性AMD的临床医生选择合适的治疗方案并预测RPE萎缩的进展。
