The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia.
The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France; Inserm, U1061, Montpellier, France.
Ophthalmology. 2019 Jan;126(1):64-74. doi: 10.1016/j.ophtha.2018.08.023. Epub 2018 Aug 24.
To explore various methods for assessing the early response to vascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration and investigate their association with 3-year visual acuity (VA) outcomes.
Database study, prospectively designed.
Treatment-naïve eyes in the Fight Retinal Blindness! registry that commenced anti-VEGF therapy between January 1, 2007, and March 1, 2014, that received 3 anti-VEGF injections within the first 3 months.
The early response was defined as occurring up until the fourth injection. Various early response metrics were explored: (1) achieving good VA (≥70 letters; Snellen equivalent, 20/40), (2) absolute change in VA from baseline, (3) time to first grading of the choroidal neovascular lesion as inactive, and (4) maximum rate of VA change between successive injections.
Proportion of eyes achieving ≥70 letters 3 years.
This study included 2051 treatment-naïve eyes from 1828 patients. Achieving good vision at 3 years was associated significantly with (1) having good vision by the fourth injection (VA ≥70 vs. VA <70 letters: odds ratio [OR], 9.8; 95% confidence interval [CI], 6.5-14.7), (2) small (1-5 letters) or large (>5 letters) early VA gains (vs. early VA loss: OR, 1.8; 95% CI, 1.2-2.6; P = 0.002; and OR, 1.8; 95% CI, 1.3-2.5; P < 0.001), (3) fewer injections until first grading of lesion inactivity (≤3 vs. >3 injections: OR, 1.6; 95% CI, 1.2-2.1; P < 0.001), (4) gradual change (between -4 and 4 letters) or rapid gains (≥5 letters) between successive injections (vs. rapid loss: OR, 1.7; 95% CI, 1.1-2.6; P = 0.015; and OR, 1.6; 95% CI, 1.1-2.3; P = 0.018). Eyes that achieved small or large early gains had similar vision at 3 years (65.0 and 64.7 letters, respectively) and had better vision than eyes with early VA loss (57.2 letters).
Attainment of good vision by the fourth injection was associated strongly with 3-year visual outcomes, whereas other early response parameters showed a moderate association. The early response during the initial 3 monthly injections can be a useful guide for subsequent treatment decisions.
探讨评估血管内皮生长因子（VEGF）抑制剂治疗新生血管性年龄相关性黄斑变性早期反应的各种方法，并研究其与 3 年视力（VA）结局的关系。
数据库研究，前瞻性设计。
2007 年 1 月 1 日至 2014 年 3 月 1 日期间开始接受抗 VEGF 治疗且在最初 3 个月内接受 3 次抗 VEGF 注射的 Fight Retinal Blindness！注册中心的治疗初治眼。
将早期反应定义为直至第四次注射。探索了各种早期反应指标：（1）达到良好的视力（≥70 个字母；Snellen 等价物，20/40），（2）基线时 VA 的绝对变化，（3）脉络膜新生血管病变首次分级为不活跃的时间，以及（4）连续注射之间 VA 变化的最大速率。
3 年后达到≥70 个字母的眼比例。
这项研究包括来自 1828 名患者的 2051 只治疗初治眼。3 年后达到良好视力与（1）第四次注射时视力良好（VA≥70 与 VA<70 个字母：优势比[OR]，9.8；95%置信区间[CI]，6.5-14.7），（2）VA 早期小（1-5 个字母）或大（>5 个字母）增益（与早期 VA 损失相比：OR，1.8；95%CI，1.2-2.6；P=0.002；和 OR，1.8；95%CI，1.3-2.5；P<0.001），（3）首次病变不活动分级所需的注射次数较少（≤3 次与>3 次注射：OR，1.6；95%CI，1.2-2.1；P<0.001），（4）连续注射之间逐渐变化（-4 至 4 个字母）或快速增益（≥5 个字母）（与快速损失相比：OR，1.7；95%CI，1.1-2.6；P=0.015；和 OR，1.6；95%CI，1.1-2.3；P=0.018）。早期获得小或大增益的眼在 3 年内具有相似的视力（分别为 65.0 和 64.7 个字母），并且比早期 VA 损失的眼具有更好的视力（57.2 个字母）。
第四次注射时达到良好视力与 3 年视力结果密切相关，而其他早期反应参数则显示出中度相关性。最初 3 个月注射期间的早期反应可以作为后续治疗决策的有用指南。
