Department of Ophthalmology, Yamanashi University Chuo Yamanashi, Japan.
Sci Rep. 2017 Mar 7;7:44020. doi: 10.1038/srep44020.
Though anti-vascular endothelial growth factor therapy has become the standard treatment for exudative age-related macular degeneration (AMD), retreatment after the initial loading injection is inevitable in most eyes with residual or recurrent exudative changes. In the present study, we studied 140 treatment naïve eyes with typical neovascular AMD (n = 71) or polypoidal choroidal vasculopathy (PCV) (n = 69) and investigated the incidence and risk factors of retreatment after 3-monthly intravitreal aflibercept injection for exudative AMD during the 12-month period. At 12 months, best-corrected visual acuity (BCVA) improved significantly from 0.45 ± 0.39 to 0.26 ± 0.33 (P = 4.1 × 10). Multiple regression analysis revealed that better baseline BCVA (P = 3.6 × 10) and thicker subfoveal choroidal thickness (P = 0.039) were associated with better BCVA at 12-months. Retreatment was required in 94 out of 140 (67.1%) eyes. Multivariate logistic regression analysis revealed that older age (P = 7.2 × 10) and T-allele of ARMS2 A69S (rs10490924) variants (P = 1.9 × 10) were associated with retreatment. Cox-regression analysis revealed that older age (P = 1.0 × 10) and T-allele of the ARMS2 gene (P = 6.0 × 10) were associated with retreatment-free period. The number of retreatment episodes was significantly different among the ARMS2 genotypes (P = 8.1 × 10). These findings might be helpful for physicians when considering the optimal treatment regimen for exudative AMD.
虽然抗血管内皮生长因子治疗已成为渗出性年龄相关性黄斑变性 (AMD) 的标准治疗方法，但在大多数有残留或复发渗出性改变的眼中，初始负荷注射后仍需要进行再治疗。在本研究中，我们研究了 140 例初次接受治疗的特发性新生血管性 AMD（n=71）或息肉样脉络膜血管病变（PCV）（n=69）患者，并在 12 个月的时间内，研究了每月 3 次玻璃体内注射阿柏西普治疗渗出性 AMD 3 个月后的复发率和再治疗的发生率及危险因素。在 12 个月时，最佳矫正视力（BCVA）从 0.45±0.39 显著提高到 0.26±0.33（P=4.1×10）。多变量回归分析显示，基线时更好的 BCVA（P=3.6×10）和更厚的中心凹下脉络膜厚度（P=0.039）与 12 个月时更好的 BCVA 相关。140 只眼中有 94 只（67.1%）需要再治疗。多变量逻辑回归分析显示，年龄较大（P=7.2×10）和 ARMS2 A69S（rs10490924）T 等位基因变异（P=1.9×10）与再治疗相关。Cox 回归分析显示，年龄较大（P=1.0×10）和 ARMS2 基因的 T 等位基因（P=6.0×10）与无再治疗期相关。ARMS2 基因型之间的再治疗次数差异有统计学意义（P=8.1×10）。这些发现可能有助于医生在考虑渗出性 AMD 的最佳治疗方案时做出决策。
