Konidaris Vasileios E, Tsaousis Konstantinos T, Anzidei Rossella, de la Mata Guillermo, Brent Alexander J
Ophthalmology Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK.
Ophthalmol Ther. 2018 Dec;7(2):387-395. doi: 10.1007/s40123-018-0149-3. Epub 2018 Oct 4.
To investigate treatment outcomes after switching from ranibizumab to aflibercept intravitreal injections in patients with macular oedema (MO) secondary to branch retinal vein occlusion (BRVO).
Eligible patients with refractory MO secondary to BRVO, post treatment with a minimum of three intravitreal injections of ranibizumab at 4-weekly intervals were recruited. Suboptimal or non-responders were defined as patients who had persistent intraretinal fluid (< 75% decrease from baseline) despite a minimum of three consecutive injections. These patients were switched to aflibercept injections on an as-needed basis. The primary study outcomes assessed trends in best-corrected distance visual acuity (BCVA) and central retinal thickness (CRT). To compare means of BCVA and CRT, a paired t test two-tailed with a level of significance set at 0.05 was used. Pearson correlation coefficient was also applied to demonstrate correlation. Participants were followed up for a period of 24 weeks after switching.
Thirty-eight eyes of 38 patients were included in the study. Patients had an average of 8.37 ranibizumab intravitreal injections over a mean period of 12 months presenting suboptimal or no response. A significant decrease of mean CRT from 388.63 ± 93.4 μm to 290.29 ± 93.5 μm (p < 0.001) and an improvement in mean BCVA from logMAR 0.66 ± 0.38 to logMAR 0.57 ± 0.27 (p = 0.025) was achieved after an average of 2.27 aflibercept injections.
Given the spectrum of therapies available to date for the management of MO secondary to BRVO, aflibercept appears to be an effective treatment option in cases refractory to ranibizumab. This study based on a small cohort of patients indicates that satisfactory results on retinal anatomy and visual outcomes can be accomplished with a smaller number of injections. Larger-scale studies are needed to extrapolate these promising results.
研究继发于视网膜分支静脉阻塞（BRVO）的黄斑水肿（MO）患者从雷珠单抗转换为阿柏西普玻璃体腔注射后的治疗效果。
招募符合条件的继发于BRVO的难治性MO患者，这些患者在至少间隔4周进行3次玻璃体腔注射雷珠单抗治疗后。治疗效果欠佳或无反应者定义为尽管连续至少注射3次仍有持续性视网膜内液（较基线下降<75%）的患者。这些患者根据需要转换为阿柏西普注射。主要研究结局评估最佳矫正远视力（BCVA）和中心视网膜厚度（CRT）的变化趋势。为比较BCVA和CRT的均值，采用双侧配对t检验，显著性水平设定为0.05。还应用Pearson相关系数来证明相关性。转换治疗后对参与者进行了24周的随访。
38例患者的38只眼纳入研究。患者平均在12个月内接受了8.37次雷珠单抗玻璃体腔注射，治疗效果欠佳或无反应。平均注射2.27次阿柏西普后，平均CRT从388.63±93.4μm显著降至290.29±93.5μm（p<0.001），平均BCVA从logMAR 0.66±0.38改善至logMAR 0.57±0.27（p=0.025）。
鉴于目前可用于治疗继发于BRVO的MO的一系列疗法，阿柏西普在对雷珠单抗难治的病例中似乎是一种有效的治疗选择。这项基于一小群患者的研究表明，较少的注射次数就能在视网膜解剖结构和视觉效果方面取得满意结果。需要进行更大规模的研究来推广这些有前景的结果。
