Todorich Bozho, Thanos Aristomenis, Yonekawa Yoshihiro, Mane Gerta, Hasbrook Madeleine, Thomas Benjamin J, Woodward Maria A, Williams George A, Capone Antonio, Wolfe Jeremy D, Faia Lisa J, Hassan Tarek S
Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI.
Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
J Vitreoretin Dis. 2017;1(1):65-74. doi: 10.1177/2474126416683299. Epub 2017 Jan 26.
To evaluate the efficacy of a dexamethasone intravitreal implant in combination with intravitreal anti-VEGF agents for treatment resistant neovascular age-related macular degeneration (nvAMD).
This study was designed as a single-center, retrospective interventional case series. Consecutive patients with treatment-resistant nvAMD underwent simultaneous combined injection of anti-VEGF agent and dexamethasone intravitreal implant. Eighteen patients with mean age of 81.5 years were included. Patients received average of 26.3 anti-VEGF injections before dual therapy, with mean follow up of 8.2 months after dual therapy.
Dual therapy produced a significant mean decrease in CFT (126.3 μm), compared to a mean increase of 29.9 μm when treated with anti-VEGF monotherapy (p=0.0017). Patients also had mean decrease in MCV of -0.85 mm with dual therapy compared with anti-VEGF monotherapy (p=0.0014). There was a moderate correlation between the number of prior anti-VEGF injections and the magnitude of anatomic response, suggesting that shorter disease duration may positively influence response to combined treatment. Although there was a slight trend towards improved mean visual acuity after dual therapy, these differences did not reach statistical significance. Nevertheless, with combination treatment, 33% of patients gained one or more lines of vision. Dual therapy resulted in a significantly lower number of required anti-VEGF injections (4.25 vs 5.33) and an increase of the anti-VEGF injection-free interval to 1.41 months from 1.12 months during the 6 months following dual therapy compared to the same interval before dual therapy. Dual therapy was well tolerated; two eyes developed mild IOP elevation effectively managed with topical therapy and one patient developed worsening cataract.
Combined treatment of anti-VEGF with the dexamethasone intravitreal implant is a viable alternative for treatment-resistant nvAMD, and may reduce treatment burden. Earlier treatment with dual therapy may be beneficial to maximize anatomic and visual outcomes in these patients.
评估地塞米松玻璃体内植入物联合玻璃体内抗血管内皮生长因子（VEGF）药物治疗难治性新生血管性年龄相关性黄斑变性（nvAMD）的疗效。
本研究设计为单中心回顾性介入病例系列研究。连续入选难治性nvAMD患者，同时接受抗VEGF药物和地塞米松玻璃体内植入物联合注射。共纳入18例患者，平均年龄81.5岁。患者在接受联合治疗前平均接受了26.3次抗VEGF注射，联合治疗后平均随访8.2个月。
与抗VEGF单药治疗时平均增加29.9μm相比，联合治疗使中央黄斑厚度（CFT）平均显著降低（126.3μm）（p = 0.0017）。与抗VEGF单药治疗相比，联合治疗患者的平均脉络膜厚度（MCV）也平均降低了-0.85mm（p = 0.0014）。既往抗VEGF注射次数与解剖学反应程度之间存在中度相关性，提示病程较短可能对联合治疗的反应产生积极影响。虽然联合治疗后平均视力有轻微改善趋势，但这些差异未达到统计学显著性。尽管如此，联合治疗使33%的患者视力提高了一行或多行。联合治疗使所需抗VEGF注射次数显著减少（4.25次对5.33次），且在联合治疗后的6个月内，抗VEGF注射间隔从1.12个月增加到1.41个月，而在联合治疗前的相同间隔期内。联合治疗耐受性良好；2只眼出现轻度眼压升高，经局部治疗有效控制，1例患者白内障病情恶化。
抗VEGF药物与地塞米松玻璃体内植入物联合治疗是难治性nvAMD的一种可行替代方案，且可能减轻治疗负担。早期采用联合治疗可能有利于使这些患者的解剖学和视觉效果最大化。
