Grüb Matthias, Lamprakis Ioannis, Reichel Christoph
Augenheilkunde, Villa im Lindengarten, Breisach am Rhein.
Augenklinik, Universitätsspital Basel, Basel, Schweiz.
Klin Monbl Augenheilkd. 2019 Jul;236(7):885-891. doi: 10.1055/s-0043-118099. Epub 2017 Oct 12.
Therapy of neovascular age-related macular degeneration, diabetic maculopathy and macular edema after retinal vein occlusion has changed fundamentally since the introduction of anti-VEGF therapy more than 10 years ago. With the technological progress in ocular coherence tomography (OCT) functional criteria have been replaced by more morphological criteria. Contract law and administrative problems have been improved but not solved totally.
PATIENTS/MATERIALS AND METHODS: In a retrospective study, 207 eyes of 157 patients who presented between January 2007 and October 2013 with neovascular age-related macular degeneration, diabetic maculopathy or macular edema after retinal vein occlusion were analyzed. Baseline visual acuity (VA) was 0.25 (median).
After initial anti-VEGF upload, there was a significant increase in VA from 0.25 to 0.32 (p < 0.001). Patients with bad VA profited most (p = 0.004). Patients with more intravitreal injections had a larger increase in VA (p = 0.002). In the mainly VA-controlled group of the first years, VA decreased to 0.05 after one year and 3.49 intravitreal injections in the mean. In the OCT-controlled group of the later years, the initial increase in VA could be held after one year and 5.03 intravitreal anti-VEGF applications in the mean. There was a significant difference in the course of VA between the two groups (p = 0.001). Mean interval between indication and start of therapy was 25.34 days in the early years, and 5.40 days in the later years.
Mainly VA-based criteria in the anti-VEGF therapy of the early years seem to be inferior to morphological criteria of the later years. Contract law and administrative problems have delayed the time between indication and start of therapy and, thereby, contributed to undersupply and worsening functional results.
自10多年前引入抗VEGF治疗以来，新生血管性年龄相关性黄斑变性、糖尿病性黄斑病变及视网膜静脉阻塞后黄斑水肿的治疗发生了根本性变化。随着光学相干断层扫描（OCT）技术的进步，功能标准已被更多的形态学标准所取代。合同法和行政问题有所改善，但尚未完全解决。
患者/材料与方法：在一项回顾性研究中，分析了2007年1月至2013年10月间因新生血管性年龄相关性黄斑变性、糖尿病性黄斑病变或视网膜静脉阻塞后黄斑水肿就诊的157例患者的207只眼。基线视力（VA）为0.25（中位数）。
首次抗VEGF注射后，VA从0.25显著提高至0.32（p＜0.001）。视力差的患者获益最大（p = 0.004）。玻璃体内注射次数较多的患者VA提高幅度更大（p = 0.002）。在最初以VA控制为主的前几年组中，一年后VA降至0.05，平均进行3.49次玻璃体内注射。在后期以OCT控制的组中，一年后VA仍能保持最初的提高水平，平均进行5.03次玻璃体内抗VEGF注射。两组间VA的变化过程存在显著差异（p = 0.001）。早年从适应证确定到治疗开始的平均间隔时间为25.34天，后期为5.40天。
早年抗VEGF治疗中主要基于VA的标准似乎不如后期的形态学标准。合同法和行政问题延迟了从适应证确定到治疗开始的时间，从而导致供应不足和功能结果恶化。
