Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.
Br J Ophthalmol. 2019 Sep;103(9):1337-1341. doi: 10.1136/bjophthalmol-2018-312944. Epub 2018 Dec 1.
To compare 24 months outcomes of eyes with retinal angiomatous proliferations (RAPs) treated with antivascular endothelial growth factor (anti-VEGF) with a group of controls diagnosed with other neovascular age-related macular degeneration (nAMD) subtypes in a real-world setting.
Treatment-naïve nAMD eyes that commenced anti-VEGF between January 2006 and November 2015 were identified from a registry of nAMD treatment outcomes. Cases were defined as eyes diagnosed with RAP. Three controls per case were selected among nAMD eyes with non-RAP lesions and matched on baseline visual acuity (VA), year of treatment initiation, anti-VEGF agent first injected and follow-up. Baseline VA was compared with 12 and 24 months VA. Change in VA, number of injections received, proportion of visits with active nAMD and time to first inactivation were compared between RAPs and controls.
157 RAPs and 469 controls were included. Baseline VA (mean (SD)) increased at 12 months (61.4 (15.5) vs 68.7 (14.7) letters, p<0.001) and remained higher (66.6 (17.3) letters) at 24 months (p<0.001) in RAPs. The change from baseline VA (mean(95% CI)) was significantly higher in RAPs than in controls at 12 months (7.3 (5.4 to 9.1) vs 4.1 (2.8 to 5.4) letters, p=0.01) and at 24 months (5.1 (2.8 to 7.3) vs 2.5 (1 to 4) letters, p=0.056). Both groups received a median of 13 injections. RAPs inactivated earlier and were less active than controls (both p<0.001).
RAPs responded well to anti-VEGF, with a significant improvement in VA persisting at 24 months. RAPs had better visual outcomes than controls at 12 and 24 months, tended to inactivate earlier and were less active throughout 2 years follow-up.
在真实环境中，比较 24 个月时接受抗血管内皮生长因子（抗-VEGF）治疗的伴有视网膜血管性增殖（RAP）的眼与一组诊断为其他新生血管性年龄相关性黄斑变性（nAMD）亚型的对照组的结果。
从 nAMD 治疗结果的登记处中确定了 2006 年 1 月至 2015 年 11 月期间开始接受抗-VEGF 治疗的未经治疗的 nAMD 眼。病例定义为诊断为 RAP 的眼。每例病例选择 3 例非 RAP 病变的 nAMD 眼作为对照，并根据基线视力（VA）、治疗起始年份、首次注射的抗-VEGF 药物和随访进行匹配。比较基线 VA 与 12 个月和 24 个月 VA。比较 RAP 与对照组之间 VA 的变化、注射次数、活跃 nAMD 就诊比例和首次失活时间。
共纳入 157 例 RAP 和 469 例对照组。RAP 的基线 VA（平均值（标准差））在 12 个月时增加（61.4（15.5）比 68.7（14.7）个字母，p<0.001），在 24 个月时仍较高（66.6（17.3）个字母）（p<0.001）。RAP 组从基线 VA 的变化（平均值（95%置信区间））在 12 个月时明显高于对照组（7.3（5.4 至 9.1）比 4.1（2.8 至 5.4）个字母，p=0.01），在 24 个月时也高于对照组（5.1（2.8 至 7.3）比 2.5（1 至 4）个字母，p=0.056）。两组均接受了中位数为 13 次注射。RAP 比对照组更早失活且更不活跃（均 p<0.001）。
RAP 对抗-VEGF 反应良好，VA 在 24 个月时持续显著改善。在 12 个月和 24 个月时，RAP 的视力结果优于对照组，在 2 年随访期间，RAP 更早失活且更不活跃。
