Sakamoto Shinichi, Takahashi Hidenori, Inoue Yuji, Arai Yusuke, Inoda Satoru, Kakinuma Natsuko, Fujino Yujiro, Tanabe Tatsuro, Kawashima Hidetoshi, Yanagi Yasuo
Department of Ophthalmology, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan,
Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan,
Clin Ophthalmol. 2018 Jun 25;12:1137-1147. doi: 10.2147/OPTH.S160961. eCollection 2018.
We report the 2-year outcomes of intravitreal aflibercept (IVA) for exudative age-related macular degeneration (AMD) with good visual acuity (VA) and examine the baseline factors associated with good visual outcome.
This multicenter, prospective study evaluated 39 eyes (39 AMD patients) enrolled from August 2013 to August 2014 at 12 and 24 months. Only patients with initial best-corrected VA (BCVA) >0.3 logarithm of the minimum angle of resolution (20/40 Snellen) were eligible. Three consecutive monthly IVA injections were followed by 2 monthly injections for 12 months. Thereafter, patients received injections on a treat- and-extend regimen for up to 24 months. Outcome measures included BCVA and central macular thickness (CMT) at 12 and 24 months. Post hoc analysis, BCVA, and CMT were evaluated by AMD types (typical AMD [tAMD], type 1, and type 2 polypoidal choroidal vasculopathy [PCV]). Baseline characteristics and BCVA associations were evaluated with linear regression analysis and Student's -test.
Mean age was 69 years and 26 of 39 eyes were male. tAMD, type 1 and type 2 PCV occurred in 18, 12, and 9 eyes, respectively. Baseline mean BCVA was 0.097 logarithm of the minimum angle of resolution (20/25 Snellen) and showed significant improvement to 0.058 (20/22 Snellen, =0.03) at 12 months and 0.066 (20/23) at 24 months. CMT improved significantly from 320 (99) µm (mean [SD]) to 250 (93) µm (=0.002) at 12 months and 240 (93) µm (=0.0005) at 24 months. BCVA and CMT were not significantly different among the three groups. Only subretinal hemorrhage (SRH) was significantly associated with improved BCVA. BCVA change from baseline was -0.12 with SRH and -0.011 without SRH (=0.017) at 12 months.
IVA showed good efficacy for exudative AMD with good VA at 24 months. tAMD and type 1 and 2 PCV showed similar prognosis. Baseline SRH predicted favorable long-term vision in AMD with good VA.
我们报告玻璃体内注射阿柏西普（IVA）治疗视力良好的渗出性年龄相关性黄斑变性（AMD）的2年结果，并研究与良好视力结果相关的基线因素。
这项多中心前瞻性研究评估了2013年8月至2014年8月期间入组的39只眼（39例AMD患者）在12个月和24个月时的情况。仅初始最佳矫正视力（BCVA）>0.3最小分辨角对数（20/40 Snellen）的患者符合条件。连续每月注射3次IVA，随后每月注射2次，共12个月。此后，患者接受按需延长治疗方案的注射，最长24个月。观察指标包括12个月和24个月时的BCVA和中心黄斑厚度（CMT）。事后分析中，通过AMD类型（典型AMD [tAMD]、1型和2型息肉样脉络膜血管病变 [PCV]）评估BCVA和CMT。通过线性回归分析和学生t检验评估基线特征与BCVA的相关性。
平均年龄为69岁，39只眼中26只为男性。tAMD、1型和2型PCV分别发生在18只、12只和9只眼中。基线平均BCVA为0.097最小分辨角对数（20/25 Snellen），在12个月时显著改善至0.058（20/22 Snellen，P = 0.03），在24个月时为0.066（20/23）。CMT在12个月时从320（99）µm（平均值[标准差]）显著改善至250（93）µm（P = 0.002），在24个月时为240（93）µm（P = 0.0005）。三组之间的BCVA和CMT无显著差异。仅视网膜下出血（SRH）与BCVA改善显著相关。12个月时，有SRH的患者BCVA较基线变化为 -0.12，无SRH的患者为 -0.011（P = 0.017）。
IVA在24个月时对视力良好的渗出性AMD显示出良好疗效。tAMD以及1型和2型PCV显示出相似的预后。基线SRH可预测视力良好的AMD患者的长期良好视力。
