高剂量高频阿柏西普治疗难治性新生血管年龄相关性黄斑变性。

HIGH-DOSE HIGH-FREQUENCY AFLIBERCEPT FOR RECALCITRANT NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

机构信息

Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, La Jolla, California.

Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

出版信息

Retina. 2018 Jun;38(6):1156-1165. doi: 10.1097/IAE.0000000000001726.

PURPOSE

To determine the efficacy of monthly (0.1 mL/4 mg) aflibercept for refractory neovascular age-related macular degeneration (wet age-related macular degeneration).

METHODS

This was a retrospective interventional case series in which patients with wet age-related macular degeneration were treated with stepwise dose escalation. Nonvitrectomized patients resistant to monthly (Q4W) ranibizumab/bevacizumab were switched to 2 mg aflibercept every 8 weeks. With resistance, they were escalated to Q4W 2 mg aflibercept, then Q4W 4 mg (high dose high frequency, 4Q4W) aflibercept. Resistance was defined as ≥2 recurrences after being dry following ≥3 injections or persistent exudation on treatment of ≥5 injections.

RESULTS

Thirty-three eyes of 28 patients were treated with 4Q4W aflibercept and followed for a mean of 16 months. A dry retina (no intraretinal or subretinal fluid) was achieved after initiating 4Q4W aflibercept treatment at a mean of 3.8 months. Central foveal thickness, maximum foveal thickness, intraretinal fluid, subretinal fluid, and retinal pigment detachment height decreased significantly at 1 month after initiating the 4Q4W aflibercept, and the morphologic therapeutic effect was sustained until the last visit. Forty-five percent of eyes had one or more lines of vision improvement. New geographic atrophy developed in 9% of eyes during follow-up. No ocular or systemic adverse events occurred after initiating 4Q4W aflibercept.

CONCLUSION

Intravitreal high-dose high-frequency aflibercept is an effective treatment for patients with refractory wet age-related macular degeneration.

目的

评估每月（0.1 mL/4 mg）阿柏西普治疗难治性新生血管性年龄相关性黄斑变性（湿性年龄相关性黄斑变性）的疗效。

方法

这是一项回顾性的介入性病例系列研究，对湿性年龄相关性黄斑变性患者进行逐步剂量递增治疗。对非玻璃体切割且对每月（Q4W）雷珠单抗/贝伐珠单抗耐药的患者，改用每 8 周注射 2 mg 阿柏西普。若耐药，则升级为 Q4W 2 mg 阿柏西普，然后是 Q4W 4 mg（高剂量高频，4Q4W）阿柏西普。耐药的定义为≥3 次注射后病情缓解（无视网膜内或视网膜下积液）但≥2 次复发，或≥5 次注射后仍有持续性渗出。

结果

28 例患者的 33 只眼接受了 4Q4W 阿柏西普治疗，平均随访 16 个月。开始 4Q4W 阿柏西普治疗后，平均 3.8 个月时达到视网膜干性（无视网膜内或视网膜下积液）。中央视网膜厚度、最大视网膜厚度、视网膜内液、视网膜下液和视网膜色素上皮脱离高度在开始 4Q4W 阿柏西普治疗后 1 个月显著下降，形态治疗效果一直持续到最后一次随访。45%的眼视力提高了 1 行或更多。在随访期间，9%的眼新出现地图样萎缩。开始 4Q4W 阿柏西普后，无眼部或全身不良事件发生。