Chen Xuejing, Al-Sheikh Mayss, Chan Clement K, Hariri Amir H, Abraham Prema, Lalezary Maziar, Lin Steven G, Sadda SriniVas, Sarraf David
*Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles, Los Angeles, California; †Department of Ophthalmology, David Geffen School of Medicine, Doheny Eye Institute, University of California Los Angeles, Los Angeles, California; ‡Southern California Desert Retina Consultants, Palm Desert, California; §Department of Ophthalmology, Loma Linda University Eye Institute, Loma Linda, California; ¶Black Hills Regional Eye Institute, Rapid City, South Dakota; and **Department of Ophthalmology, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA.
Retina. 2016 Dec;36 Suppl 1:S50-S64. doi: 10.1097/IAE.0000000000001271.
To evaluate the response to aflibercept therapy for Type 1 and Type 3 neovascularization in pigment epithelial detachments associated with treatment-naive, neovascular age-related macular degeneration.
In this multicentered, prospective study, eligible eyes underwent an intravitreal aflibercept injection protocol for 12 months. Visual acuity and morphologic features of the pigment epithelial detachments were compared at baseline and follow-up intervals between eyes with Type 1 versus Type 3 neovascularization.
Thirty-six eyes were analyzed. At 12 months, Type 1 lesions showed a 4.5 ± 23 Early Treatment of Diabetic Retinopathy Study letter improvement (P = 0.1665) versus a 14 ± 11 (P = 0.0072) letter improvement with Type 3 lesions. Both Type 1 and 3 eyes showed a significant decrease in pigment epithelial detachment size, subretinal fluid, and subretinal hyperreflective material; however, Type 3 eyes had a greater reduction in pigment epithelial detachment size and subretinal hyperreflective material, as well as a reduction in central retinal thickness. Type 1 eyes required an average of 1.636 (range, 1-4) injections to resolve fluid, which was greater than Type 3 eyes, which required an average of 1.143 (range, 1-2) injections (P = 0.0251).
Intravitreal aflibercept injections were efficacious for pigment epithelial detachments, but baseline and follow-up anatomical and functional outcomes differed in Type 1 versus Type 3 neovascularization. The better response of Type 3 eyes with fewer injections suggests that differentiation of the neovascularization subtype at the initial diagnosis may allow for a more tailored, optimal therapy.
评估阿柏西普治疗初治的新生血管性年龄相关性黄斑变性相关色素上皮脱离中1型和3型新生血管的疗效。
在这项多中心前瞻性研究中，符合条件的眼睛接受了为期12个月的玻璃体内注射阿柏西普方案。比较了1型和3型新生血管眼睛在基线和随访期间色素上皮脱离的视力和形态学特征。
分析了36只眼睛。在12个月时，1型病变的早期糖尿病视网膜病变研究字母视力提高了4.5±23（P = 0.1665），而3型病变提高了14±11（P = 0.0072）。1型和3型眼睛的色素上皮脱离大小、视网膜下液和视网膜下高反射物质均显著减少；然而，3型眼睛的色素上皮脱离大小和视网膜下高反射物质减少更多，同时中心视网膜厚度也有所减少。1型眼睛平均需要1.636次（范围1 - 4次）注射来消除积液，这比3型眼睛多，3型眼睛平均需要1.143次（范围1 - 2次）注射（P = 0.0251）。
玻璃体内注射阿柏西普对色素上皮脱离有效，但1型和3型新生血管在基线和随访时的解剖和功能结果有所不同。3型眼睛反应更好且注射次数更少，这表明在初始诊断时区分新生血管亚型可能有助于制定更有针对性的最佳治疗方案。
