Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland.
Retina. 2019 Aug;39(8):1519-1526. doi: 10.1097/IAE.0000000000002200.
To evaluate, in eyes with radiation maculopathy, the effect of 2-month-interval anti-vascular endothelial growth factor therapy on best-corrected visual acuity and foveal avascular zone (FAZ) enlargement using optical coherence tomography angiography.
Consecutive treatment-naive patients with radiation maculopathy after proton beam irradiation for choroidal melanoma were retrospectively included. Clinical and optical coherence tomography angiography data at baseline and the 6-month visit were recorded. Two independent observers measured FAZ area manually on 3 × 3-mm optical coherence tomography angiography images of the superficial capillary plexus and deep capillary plexus. Patients were encouraged to follow strictly a 2-month-interval intravitreal anti-vascular endothelial growth factor treatment by either bevacizumab or ranibizumab. Findings were analyzed based on the adherence to the treatment scheme.
According to the adherence to the bimonthly anti-vascular endothelial growth factor treatment protocol, patients were categorized into 3 groups: treatment protocol (n = 19, strict adherence), variable intervals (n = 11, intervals other than 2 months), and no treatment (n = 11). The estimated radiation dose to the foveola in each group was 49 ± 16, 46 ± 17, and 46 ± 18 cobalt gray equivalent, respectively (P = 0.85). For the entire cohort, best-corrected visual acuity loss (P < 0.02) and FAZ enlargement (P < 0.0001) were observed over 6 months. Best-corrected visual acuity loss was significantly less pronounced in the treatment-protocol group than in the variable-interval and no-treatment groups (P = 0.007 and P = 0.004). The FAZ enlargement was lower in the treatment-protocol group compared with the variable-interval group for both superficial capillary plexus (P = 0.029) and deep capillary plexus (P = 0.03), and to the no-treatment group for the deep capillary plexus only (P = 0.016).
Decrease in best-corrected visual acuity and FAZ enlargement on optical coherence tomography angiography occurred over 6 months in eyes with radiation maculopathy and were significantly reduced under 2-month-interval anti-vascular endothelial growth factor therapy.
利用光相干断层扫描血管造影术评估质子束照射治疗脉络膜黑色素瘤后发生放射性黄斑病变患者接受每 2 个月间隔的抗血管内皮生长因子治疗对最佳矫正视力和中心凹无血管区（FAZ）扩大的影响。
回顾性纳入连续接受质子束照射治疗后出现放射性黄斑病变且未经治疗的脉络膜黑色素瘤患者。记录基线和 6 个月就诊时的临床和光相干断层扫描血管造影数据。两名独立观察者在浅层毛细血管丛和深层毛细血管丛的 3×3mm 光相干断层扫描血管造影图像上手动测量 FAZ 面积。鼓励患者严格遵循每 2 个月间隔的玻璃体内抗血管内皮生长因子治疗方案，治疗药物为贝伐单抗或雷珠单抗。根据对治疗方案的依从性对结果进行分析。
根据对每 2 个月间隔抗血管内皮生长因子治疗方案的依从性，患者分为 3 组：治疗方案组（n=19，严格依从）、间隔时间不定组（n=11，间隔时间非 2 个月）和未治疗组（n=11）。每组的黄斑区受照剂量分别为 49±16、46±17 和 46±18 钴Gray 等效剂量（P=0.85）。对于整个队列，在 6 个月时观察到最佳矫正视力损失（P＜0.02）和 FAZ 扩大（P＜0.0001）。与间隔时间不定组和未治疗组相比，治疗方案组的最佳矫正视力损失明显较轻（P=0.007 和 P=0.004）。与间隔时间不定组相比，治疗方案组浅层毛细血管丛（P=0.029）和深层毛细血管丛（P=0.03）的 FAZ 扩大较小，与未治疗组相比仅深层毛细血管丛的 FAZ 扩大较小（P=0.016）。
放射性黄斑病变患者在 6 个月时，光相干断层扫描血管造影显示最佳矫正视力下降和 FAZ 扩大，接受每 2 个月间隔的抗血管内皮生长因子治疗后明显减少。
