在新生血管性年龄相关性黄斑变性（neovascular AMD）患者中，初始使用贝伐单抗治疗后改用阿柏西普或雷珠单抗。
Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD.
作者信息
Waizel Maria, Todorova Margarita G, Masyk Michael, Wolf Katharina, Rickmann Annekatrin, Helaiwa Khaled, Blanke Björn R, Szurman Peter
机构信息
Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031, Basel, Switzerland.
Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany.
出版信息
BMC Ophthalmol. 2017 May 23;17(1):79. doi: 10.1186/s12886-017-0471-x.
BACKGROUND
To evaluate changes in central macular thickness (CMT) and visual outcome in patients with neovascular age-related macular degeneration (AMD) treated initially with bevacizumab and subsequently switched to either aflibercept or ranibizumab.
METHODS
Observational clinical study was performed. We measured the structural outcome (CMT on SD-OCT; μm) and the visual outcome (best corrected visual acuity (BCVA); logMAR), as follows: before treatment (at baseline), following bevacizumab treatment (switch follow-up) and after switching from bevacizumab to aflibercept- or ranibizumab treatment (final follow-up, AG/, RG).
RESULTS
From a total of 96 eyes treated with intravitreal injections of bevacizumab (10.5 ± 7.6 (mean ± SD)), 58 eyes switched to aflibercept (6.5 ± 3.9; AG) and 38 eyes switched to ranibizumab (7.1 ± 5.3; RG) (≥ 3 injections, each). In addition, these eyes were compared to 37 eyes under bevacizumab monotherapy.
PRIMARY OUTCOME
In the AG, the CMT decreased slightly from 430 ± 220 μm at baseline to 419 ± 212 μm at switch follow-up (p = 0.86), but decreased significantly to 318 ± 159 μm at final follow-up, AG (p < 0.0001). In the ranibizumab group (RG), the CMT increased from 396 ± 174 μm at baseline to 499 ± 333 μm at switch follow-up (p = 0.012), but decreased significantly to 394 ± 202 μm at final follow-up, RG (p = 0.007). Secondary outcome: In the AG, the mean BCVA worsened from logMAR 0.57 ± 0.33 at baseline to 0.63 ± 0.30 at switch follow-up and improved slightly to 0.53 ± 0.71 at final follow-up, AG (p = 0.46). In the RG, mean BCVA worsened from 0.57 ± 0.28 at baseline to 0.64 ± 0.31 at switch follow-up and improved slightly to 0.60 ± 0.36 at final follow-up, RG (p = 0.64).
CONCLUSION
Switching from bevacizumab to either aflibercept, or ranibizumab, has a strong anatomical effect in eyes with neovascular AMD. Nevertheless, even if the switch to aflibercept shows a minimal functional benefit over that to ranibizumab, visual prognosis remains limited.
背景
评估初始接受贝伐单抗治疗，随后改用阿柏西普或雷珠单抗治疗的新生血管性年龄相关性黄斑变性（AMD）患者的中心黄斑厚度（CMT）变化和视觉转归。
方法
进行观察性临床研究。我们测量了结构转归（SD-OCT上的CMT；μm）和视觉转归（最佳矫正视力（BCVA）；logMAR），如下：治疗前（基线时）、贝伐单抗治疗后（转换随访）以及从贝伐单抗转换为阿柏西普或雷珠单抗治疗后（最终随访，AG/，RG）。
结果
总共96只眼接受了玻璃体内注射贝伐单抗治疗（10.5±7.6（平均值±标准差）），58只眼改用阿柏西普（6.5±3.9；AG），38只眼改用雷珠单抗（7.1±5.3；RG）（均≥3次注射）。此外，将这些眼与37只接受贝伐单抗单药治疗的眼进行比较。
主要转归
在AG组，CMT从基线时的430±220μm略有下降至转换随访时的419±212μm（p = 0.86），但在最终随访时显著下降至318±159μm，AG组（p < 0.0001）。在雷珠单抗组（RG），CMT从基线时的396±174μm增加至转换随访时的499±333μm（p = 0.012），但在最终随访时显著下降至394±202μm，RG组（p = 0.007）。次要转归：在AG组，平均BCVA从基线时的logMAR 0.57±0.33恶化至转换随访时的0.63±0.30，并在最终随访时略有改善至0.53±0.71，AG组（p = 0.46）。在RG组，平均BCVA从基线时的0.57±0.28恶化至转换随访时的0.64±0.31，并在最终随访时略有改善至0.60±0.36，RG组（p = 0.64）。
结论
从贝伐单抗转换为阿柏西普或雷珠单抗，对新生血管性AMD患眼有显著的解剖学效果。然而，即使转换为阿柏西普比转换为雷珠单抗显示出最小的功能益处，视觉预后仍然有限。
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