Kikushima Wataru, Sakurada Yoichi, Sugiyama Atsushi, Tanabe Naohiko, Yoneyama Seigo, Iijima Hiroyuki
Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan.
Jpn J Ophthalmol. 2017 Jan;61(1):61-66. doi: 10.1007/s10384-016-0479-4. Epub 2016 Sep 23.
To investigate the incidence, risk factors and effect on visual improvement of retreatment within 60 months after initial photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) in eyes with treatment-naïve polypoidal choroidal vasculopathy (PCV).
We retrospectively reviewed the medical records of 61 eyes from 60 patients with PCV, who were followed up for at least 12 months after undergoing combination therapy. Retreatment, including combination therapy or IVR alone, was administered if residual or recurrent exudative changes were present.
During the follow-up period (mean 44 ± 13 months, median 48 months), 46 eyes (75.4 %) underwent retreatment. Survival analysis revealed that the proportions of eyes that were retreatment-free were 59 % at the 12-month visit, 41 % at the 24 month, 31 % at the 36 month, and 20 % at the 60-month visit. The median retreatment-free period was 15.0 [95 % confidence interval (CI) 7.4-22.7] months, and the mean period was 24.9 (95 % CI 19.3-30.6) months. Cox regression analysis revealed that older age (P = 0.010, hazard ratio 1.06, CI 1.02-1.11) and male gender (P = 0.043, hazard ratio 2.41, CI 1.03-5.62) were associated with retreatment. Visual improvement was significantly better in eyes without retreatment compared with those with retreatment at the 12-, 24- and 48-month visits.
About 80 % of eyes with PCV require retreatment within 5 years after combination therapy with PDT and IVR. Retreatment is associated with older age and male gender and is related to reduced improvement of visual acuity.
研究初治息肉状脉络膜血管病变（PCV）患者在首次光动力疗法（PDT）联合玻璃体内注射雷珠单抗（IVR）后60个月内再次治疗的发生率、危险因素及其对视力改善的影响。
我们回顾性分析了60例PCV患者61只眼的病历，这些患者在接受联合治疗后至少随访了12个月。如果存在残留或复发性渗出性改变，则进行再次治疗，包括联合治疗或单独使用IVR。
在随访期间（平均44±13个月，中位数48个月），46只眼（75.4%）接受了再次治疗。生存分析显示，在12个月随访时未再次治疗的眼比例为59%，24个月时为41%，36个月时为31%，60个月时为20%。无再次治疗的中位时间为15.0[95%置信区间（CI）7.4 - 22.7]个月，平均时间为24.9（95%CI 19.3 - 30.6）个月。Cox回归分析显示，年龄较大（P = 0.010，风险比1.06，CI 1.02 - 1.11）和男性（P = 0.043，风险比2.41，CI 1.03 - 5.62）与再次治疗相关。在12个月、24个月和48个月随访时，未再次治疗的眼视力改善明显优于再次治疗的眼。
约80%的PCV患者在PDT和IVR联合治疗后5年内需要再次治疗。再次治疗与年龄较大和男性性别相关，并且与视力改善降低有关。
