Kowalczuk Laura, Matet Alexandre, Dirani Ali, Daruich Alejandra, Ambresin Aude, Mantel Irmela, Spaide Richard F, Turck Natacha, Behar-Cohen Francine
Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland.
Vitreous, Retina, Macula Consultants of New York and LuEsther T. Mertz Retina Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York.
Retina. 2017 Dec;37(12):2226-2237. doi: 10.1097/IAE.0000000000001424.
To evaluate intravitreal aflibercept in macular telangiectasia Type 1 (MacTel 1) patients and measure their ocular angiogenic profile.
Eight subjects with MacTel 1 refractory to bevacizumab, ranibizumab, or laser therapy and switched to aflibercept were included. Best-corrected visual acuity, central macular thickness, and cystic areas quantified on optical coherence tomography B-scans were assessed during 12 months. Perifoveal capillary densities were measured on optical coherence tomography angiography. Aqueous humor was sampled from six patients and eight control subjects undergoing cataract extraction. Growth factors were quantified using a multiarray immunoassay.
Over 12 months, patients received 6.6 ± 1.4 (range, 5-8) intravitreal aflibercept injections. Twelve months after switching to aflibercept, best-corrected visual acuity increased by ≥5 letters in 5 of 8 patients, compared with preaflibercept levels. Mean best-corrected visual acuity improved from 79.6 (∼20/50) to 88.0 (∼20/35) Early Treatment Diabetic Retinopathy Study letters (P = 0.042), and central macular thickness decreased from 434 ± 98 μm to 293 ± 59 μm (P = 0.014). Compared with control subjects, the profile of angiogenic factors in MacTel 1 eyes revealed no difference in vascular endothelial growth factor-A levels but significantly higher levels of placental growth factor (P = 0.029), soluble vascular endothelial growth factor receptor-1 (sFlt-1; P = 0.013), vascular endothelial growth factor-D (P = 0.050), and Tie-2 (P = 0.019). Placental growth factor levels inversely correlated with both superficial and deep capillary plexus densities on optical coherence tomography angiography (P = 0.03).
The clinical response to aflibercept coupled to the angiogenic profile of MacTel 1 eyes support the implication of the placental growth factor/Flt-1 pathway in MacTel 1.
评估玻璃体内注射阿柏西普治疗1型黄斑毛细血管扩张症（MacTel 1）患者的效果，并测量其眼部血管生成特征。
纳入8例对贝伐单抗、雷珠单抗或激光治疗无效且改用阿柏西普的MacTel 1患者。在12个月内评估最佳矫正视力、中心黄斑厚度以及光学相干断层扫描B扫描上量化的囊性区域。通过光学相干断层扫描血管造影测量黄斑中心凹周围的毛细血管密度。从6例患者和8例接受白内障摘除术的对照受试者中采集房水。使用多阵列免疫测定法定量生长因子。
在12个月期间，患者接受了6.6±1.4（范围5 - 8）次玻璃体内注射阿柏西普。改用阿柏西普12个月后，8例患者中有5例的最佳矫正视力较注射前提高了≥5行。平均最佳矫正视力从早期糖尿病性视网膜病变研究的79.6（约20/50）提高到88.0（约20/35）（P = 0.042），中心黄斑厚度从434±98μm降至293±59μm（P = 0.014）。与对照受试者相比，MacTel 1患者眼中血管生成因子的特征显示血管内皮生长因子-A水平无差异，但胎盘生长因子、可溶性血管内皮生长因子受体-1（sFlt-1）、血管内皮生长因子-D和Tie-2水平显著更高（P分别为0.029、0.013、0.050和0.019）。胎盘生长因子水平与光学相干断层扫描血管造影上的浅表和深部毛细血管丛密度呈负相关（P = 0.03）。
阿柏西普的临床反应以及MacTel 1患者眼的血管生成特征支持胎盘生长因子/Flt-1途径与MacTel 1有关。
