Zhao Meng, Zhou Hai-Ying, Xu Jun, Zhang Feng, Wei Wen-Bin, Liu Ning-Pu
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China.
Int J Ophthalmol. 2017 Mar 18;10(3):413-422. doi: 10.18240/ijo.2017.03.14. eCollection 2017.
To report a cohort of patients with polypoidal choroidal vasculopathy (PCV) treated with photodynamic therapy (PDT) followed by intravitreal ranibizumab injection 24-48h later, and to compare the results between eyes with PCV treated by PDT followed by intravitreal anti-vascular endothelial growth factor (VEGF) injection and intravitreal anti-VEGF injection followed by PDT by Meta-analysis.
Retrospective study and systematic literature review. Medical records of patients with PCV who were initially treated using PDT followed by intravitreal ranibizumab injection 24-48h after PDT and had completed at least 2y follow-up were reviewed and analyzed. Clinical data, including age, sex, best-corrected visual acuity (BCVA), fundus photograph, fluorescein angiography, indocyanine green angiography and optical coherence tomography were investigated. A systematic literature review was also conducted, and a visual outcome of studies over 1y was compared using Meta-analysis.
A total of 52 patients were included in the study. Mean BCVA at baseline and follow-up at 1 or 2y were 0.71±0.61, 0.51±0.36 and 0.68±0.51 logMAR, respectively. The cumulative hazard rate for recurrence at 1 and 2y follow-up was 15.4% and 30.3% respectively. The percentage of eyes with polyps regression at 3, 12 and 24mo follow-up was 88.5%, 84.6% and 67.3% respectively. A Meta-analysis based on 22 independent studies showed the overall vision improvements at 1, 2 and 3y follow-up were 0.13±0.04 (<0.001), 0.12±0.03 (<0.001), 0.16±0.06 (<0.001), respectively. The proportion of polyps regression at 1y follow-up was 64.6% (95%CI: 51.5%, 77.7%, <0.001) in 434 eyes treated by intravitreal anti-VEGF agents before PDT and 76.0% (95%CI: 64.8%, 87.3%, =0.001) in 199 eyes treated by intravitreal anti-VEGF agents after PDT.
Intravitreal ranibizumab injection 24-48h following PDT effectively stabilizes visual acuity in the eye with PCV. PDT followed by intravitreal anti-VEGF agents may contribute to a relatively higher proportion of polyps' regression as compared to that of intravitreal anti-VEGF before PDT.
报告一组接受光动力疗法（PDT）治疗，随后在24 - 48小时后玻璃体内注射雷珠单抗的息肉样脉络膜血管病变（PCV）患者，并通过Meta分析比较PDT联合玻璃体内抗血管内皮生长因子（VEGF）注射与玻璃体内抗VEGF注射联合PDT治疗PCV患眼的结果。
回顾性研究和系统文献综述。对最初接受PDT治疗，随后在PDT后24 - 48小时进行玻璃体内雷珠单抗注射且完成至少2年随访的PCV患者的病历进行回顾和分析。调查临床数据，包括年龄、性别、最佳矫正视力（BCVA）、眼底照片、荧光素血管造影、吲哚菁绿血管造影和光学相干断层扫描。还进行了系统文献综述，并使用Meta分析比较1年以上研究的视觉结果。
本研究共纳入52例患者。基线时、1年和2年随访时的平均BCVA分别为0.71±0.61、0.51±0.36和0.68±0.51 logMAR。1年和2年随访时复发的累积风险率分别为15.4%和30.3%。在3个月、12个月和24个月随访时息肉消退的患眼百分比分别为88.5%、84.6%和67.3%。基于22项独立研究的Meta分析显示，在1年、2年和3年随访时总体视力改善分别为0.13±0.04（<0.001）、0.12±0.03（<0.001）、0.16±0.06（<0.001）。在PDT前接受玻璃体内抗VEGF药物治疗的434只眼中，1年随访时息肉消退的比例为64.6%（95%CI：51.5%，77.7%，<0.001）；在PDT后接受玻璃体内抗VEGF药物治疗的199只眼中，该比例为76.0%（95%CI：64.8%，87.3%，=0.001）。
PDT后24 - 48小时玻璃体内注射雷珠单抗可有效稳定PCV患眼的视力。与PDT前玻璃体内抗VEGF治疗相比，PDT联合玻璃体内抗VEGF药物治疗可能使息肉消退的比例相对更高。
