Sugiyama Atsushi, Sakurada Yoichi, Honda Shigeru, Miki Akiko, Matsumiya Wataru, Yoneyama Seigo, Kikushima Wataru, Iijima Hiroyuki
Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Japan.
Ophthalmologica. 2018;239(1):52-59. doi: 10.1159/000480439. Epub 2017 Oct 19.
The aim of this study was to investigate the clinical implications of required retreatment after 3-monthly intravitreal ranibizumab (IVR) injections followed by as-needed reinjections up to 5 years in eyes with exudative age-related macular degeneration (AMD).
A retrospective cohort study was conducted for 165 treatment-naïve eyes from 165 patients with exudative AMD. Visual changes were investigated in terms of the required retreatments.
Retreatment-free proportions were 37.0, 23.7, 16.6, 12.1, and 10.5% at 12, 24, 36, 48, and 60 months, respectively. Visual changes were significantly better in eyes which did not require retreatment at every yearly checkpoint within the 5 years. A multivariate logistic regression analysis revealed that requirement of additional IVR treatments in the first 12-24 months was associated with the T allele (risk allele) of ARMS2 A69S (p = 0.010 and 0.015, respectively). Cox regression analysis revealed that older age (p = 0.046) and the T allele of ARMS2 A69S (p = 0.036) were associated with required retreatment within the 5-year follow-up period.
Age and the T allele of ARMS2 A69S are the risk factors requiring retreatments, leading to poor visual change in eyes with exudative AMD following the initial 3-monthly IVR.
本研究旨在探讨在渗出性年龄相关性黄斑变性（AMD）患者眼中，每月玻璃体腔注射雷珠单抗（IVR）3个月，随后根据需要再注射长达5年之后进行再次治疗的临床意义。
对165例初治的渗出性AMD患者的165只眼进行回顾性队列研究。根据所需的再次治疗情况调查视力变化。
在12、24、36、48和60个月时，无需再次治疗的比例分别为37.0%、23.7%、16.6%、12.1%和10.5%。在5年期间每年检查点无需再次治疗的眼中，视力变化明显更好。多因素逻辑回归分析显示，在最初12 - 24个月内需要额外IVR治疗与ARMS2 A69S的T等位基因（风险等位基因）相关（p分别为0.010和0.015）。Cox回归分析显示，年龄较大（p = 0.046）和ARMS2 A69S的T等位基因（p = 0.036）与5年随访期内需要再次治疗相关。
年龄和ARMS2 A69S的T等位基因是需要再次治疗的危险因素，导致最初每月一次IVR治疗后的渗出性AMD患者视力变化不佳。
