年龄相关性黄斑变性治疗试验比较中伴有硬性渗出的眼睛的视觉和形态学结果
Visual and Morphologic Outcomes in Eyes with Hard Exudate in the Comparison of Age-Related Macular Degeneration Treatments Trials.
作者信息
Daniel Ebenezer, Grunwald Juan E, Kim Benjamin J, Maguire Maureen G, Jaffe Glenn J, Toth Cynthia A, Ferris Frederick L, Martin Daniel F, Shaffer James, Ying Gui-Shuang
机构信息
Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States.
出版信息
Ophthalmol Retina. 2017 Jan-Feb;1(1):25-33. doi: 10.1016/j.oret.2016.09.001.
PURPOSE
To compare baseline characteristics, visual acuity (VA) and morphological outcomes between eyes with baseline hard exudates (HE) and all other eyes among patients with neovascular age-related macular degeneration (NVAMD) treated with anti-vascular endothelial growth factors (anti-VEGF).
DESIGN
Prospective cohort study within the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).
PARTICIPANTS
Patients with NVAMD.
METHODS
Readers evaluated baseline and follow-up morphology on digital color images, fluorescein angiography (FA), and optical coherence tomography (OCT) in eyes with NVAMD that were randomly assigned to treatment with either ranibizumab or bevacizumab. Ophthalmologists identified HE on color images in the study eye.
MAIN OUTCOME MEASURES
VA; scar; geographic atrophy; retinal thickness, fluid; and number of anti-VEGF injections.
RESULTS
HE was present in 128 of 1185 (11%) study eyes at baseline, 77% within 1 disc diameter of the foveal center. Patients with study eye HE were more likely female (81% vs 60%; p<0.001) and non-smokers (53% vs 42%; p=0.004). Both groups had similar proportions of hypercholesterolemia and hypertriglyceridemia. At baseline, eyes with HE had worse VA (mean 57 vs 61 letters; p=0.003), larger total lesion size (3.3 vs 2.4 DA; p <0.001), greater total foveal thickness (522µm vs 452µm; p<0.001), more retinal angiomatous proliferation (18% vs 10%; p=0.009) and sub-RPE fluid (65% vs 47%; p<0.001). At 1 year, VA was similar in both groups; more eyes with baseline HE had no fluid (45% vs 29%; p<0.001) and greater reduction in total foveal thickness (-266µm vs -158u; p<0.001). VA at year 2 was similar but retinas of eyes with baseline HE were thinner (267µm vs 299µm; p=0.03) and fewer eyes had sub-retinal fluid (23% vs 36%; p=0.008). HE was present in 19% of eyes at 1 year and 5% of eyes at 2 years. LIPC promoter SNP rs10468017 was not associated with NVAMD HE.
CONCLUSION
Eyes with HE have larger CNV lesions and more RAP. Their initially thicker retina rapidly becomes thinner on anti-VEGF treatment. HE is not significantly associated with hyperlipidemia. HE at baseline does not significantly influence VA, scar and GA outcomes in eyes with NVAMD treated with anti-VEGF. Few eyes have HE at year 2.
目的
比较接受抗血管内皮生长因子（抗VEGF）治疗的新生血管性年龄相关性黄斑变性（NVAMD）患者中，基线时有硬性渗出（HE）的眼与所有其他眼之间的基线特征、视力（VA）和形态学结果。
设计
年龄相关性黄斑变性治疗试验比较（CATT）中的前瞻性队列研究。
参与者
NVAMD患者。
方法
阅片者在随机分配接受雷珠单抗或贝伐单抗治疗的NVAMD眼中，评估数字彩色图像、荧光素血管造影（FA）和光学相干断层扫描（OCT）的基线和随访形态。眼科医生在研究眼中的彩色图像上识别HE。
主要观察指标
VA；瘢痕；地图样萎缩；视网膜厚度、积液；以及抗VEGF注射次数。
结果
1185只研究眼中，128只（11%）在基线时有HE，77%位于黄斑中心1个视盘直径范围内。研究眼有HE的患者女性比例更高（81%对60%；p<0.001），非吸烟者比例更高（53%对42%；p=0.004）。两组高胆固醇血症和高甘油三酯血症的比例相似。基线时，有HE的眼视力更差（平均57对61个字母；p=0.003），总病变面积更大（3.3对2.4视盘面积；p<0.001），黄斑总厚度更大（522μm对452μm；p<0.001），视网膜血管瘤样增殖更多（18%对10%；p=0.009），视网膜色素上皮下积液更多（65%对%；p<0.001）。1年时，两组视力相似；基线时有HE的眼中，无积液的眼更多（45%对29%；p<0.001），黄斑总厚度降低更多（-266μm对-158μm；p<0.001）。2年时视力相似，但基线时有HE的眼视网膜更薄（267μm对299μm；p=0.03），视网膜下积液的眼更少（23%对36%；p=0.008）。1年时19%的眼中有HE，2年时5%的眼中有HE。脂质运载蛋白启动子单核苷酸多态性rs10468017与NVAMD的HE无关。
结论
有HE的眼脉络膜新生血管病变更大，视网膜血管瘤样增殖更多。其最初较厚的视网膜在抗VEGF治疗后迅速变薄。HE与高脂血症无显著关联。基线时的HE对视接受抗VEGF治疗的NVAMD眼的VA、瘢痕和地图样萎缩结果无显著影响。2年时很少有眼有HE。
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