Iacono Pierluigi, Battaglia Parodi Maurizio, Iuliano Lorenzo, Bandello Francesco
G.B. Bietti Fondation, IRCCS, Rome, Italy.
Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy.
Retina. 2018 Jan;38(1):84-90. doi: 10.1097/IAE.0000000000001500.
To evaluate the efficacy of intravitreal ranibizumab in the treatment of myopic choroidal neovascularization (mCNV) complicated by vitreoretinal interface alterations.
Thirty-two patients affected by mCNV and concurrent vitreoretinal interface disorders, including macular epiretinal membrane (18 patients), lamellar macular hole (4 patients), full-thickness macular hole (1 patient), broad/focal vitreomacular traction (3 patients), broad/focal vitreomacular adhesion (4 patients), and myopic foveoschisis (2 patients), were enrolled in a prospective study. After a comprehensive ophthalmologic examination, including best-corrected visual acuity (BCVA), fluorescein angiography, and spectral-domain optical coherence tomography, each patient received a first intravitreal ranibizumab. Further re-treatments were performed in the presence of choroidal neovascularization activity (new hemorrhages, leakage on fluorescein angiography, intraretinal/subretinal fluid on spectral-domain optical coherence tomography, visual acuity loss of five letters). Main outcome measure was the change in the BCVA and in the central foveal thickness. Data were compared with the historical control group with uncomplicated mCNV.
The median BCVA in the epiretinal membrane-myopic choroidal neovascularization subgroup showed a stabilization from the baseline value of 0.30 logarithm of minimal angle resolution (20/40) to 0.40 (20/50, P: 0.49) at the last visit (30 ± 13 months). Median BCVA significantly improved from 0.30 (20/40) to 0.10 (20/25, P: 0.0005) in the mCNV group and was better than the epiretinal membrane-myopic choroidal neovascularization subgroup (0.008). Central foveal thickness reduced significantly within both groups, with no difference between the groups at the final examination. Considering the vitreoretinal alterations with lower prevalence, BCVA stabilization was registered after a follow-up of 28.9 ± 13 months, with a median BCVA of 0.3 logarithm of minimal angle resolution (20/40) at the baseline and at the final examination. A nonstatistically significant reduction in the median central foveal thickness was registered at the final examination (P: 0.12).
The data show that ranibizumab is effective in controlling mCNV activity when associated with vitreoretinal interface alterations. However, a visual recovery was observed only in patients with uncomplicated mCNV.
评估玻璃体内注射雷珠单抗治疗合并玻璃体视网膜界面改变的近视性脉络膜新生血管（mCNV）的疗效。
32例患有mCNV并伴有玻璃体视网膜界面疾病的患者纳入一项前瞻性研究，这些疾病包括黄斑视网膜前膜（18例）、黄斑板层裂孔（4例）、黄斑全层裂孔（1例）、广泛/局限性玻璃体黄斑牵引（3例）、广泛/局限性玻璃体黄斑粘连（4例）以及近视性黄斑劈裂（2例）。在进行包括最佳矫正视力（BCVA）、荧光素血管造影和光谱域光学相干断层扫描在内的全面眼科检查后，每位患者接受首次玻璃体内注射雷珠单抗。在脉络膜新生血管活动（新出血、荧光素血管造影渗漏、光谱域光学相干断层扫描显示视网膜内/视网膜下液渗漏、视力下降5行）时进行进一步的再次治疗。主要观察指标是BCVA和中心凹厚度的变化。将数据与未合并复杂情况的mCNV历史对照组进行比较。
视网膜前膜 - 近视性脉络膜新生血管亚组的BCVA中位数从基线值最小分辨角对数（logMAR）0.30（20/40）稳定至末次随访时的0.40（20/50，P：0.49）（30 ± 13个月）。mCNV组的BCVA中位数从0.30（20/40）显著改善至0.10（20/25，P：0.0005），且优于视网膜前膜 - 近视性脉络膜新生血管亚组（P：0.008）。两组的中心凹厚度均显著降低，末次检查时两组之间无差异。考虑到患病率较低类型的玻璃体视网膜改变，随访28.9 ± 13个月后BCVA稳定，基线和末次检查时BCVA中位数均为最小分辨角对数0.3（20/40）。末次检查时中心凹厚度中位数有非统计学意义的降低（P：0.12）。
数据表明，雷珠单抗在与玻璃体视网膜界面改变相关时可有效控制mCNV活动。然而，仅在未合并复杂情况的mCNV患者中观察到视力恢复。
