Calvo-Gonzalez Cristina, Reche-Frutos Juan, Fernández-Vigo José Ignacio, Donate-López Juan, Serrano-García Irene, Fernández-Pérez Cristina
Department of Ophthalmology, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), c/Profesor Martin Lagos, 28040, Madrid, Spain.
Department of Preventive Medicine, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
Int Ophthalmol. 2019 Nov;39(11):2441-2448. doi: 10.1007/s10792-019-01082-z. Epub 2019 Feb 14.
To describe indocyanine green angiography (ICGA) and visual acuity (VA) results in patients with neovascular age-related macular degeneration (nAMD) refractory to ranibizumab switched to aflibercept.
This study is a prospective interventional case series. Thirty-two eyes of 32 patients with nAMD showing a poor response after at least 24 months of ranibizumab were switched to aflibercept. Twenty eyes had type I choroidal neovascularization (CNV group), and 12 eyes had polypoidal choroidal vasculopathy (PCV group). After an initial loading dose of three monthly aflibercept injections, treatment was continued on a treat-and-extend basis. ICGA was performed just before the first aflibercept injection (baseline) and 12 and 24 months later. The variables recorded were: closure of polyps and lesion area, VA, number of aflibercept injections, dry macula, and pigment epithelium detachment.
The following means were recorded in the CNV and PCV groups, respectively: number of ranibizumab injections 20.4 ± 11.2 and 22.4 ± 12.9 (p = 0.740); baseline VA (before aflibercept) 73.2 ± 9.1 and 70.3 ± 13.7 letters (p = 0.654); and final VA 73.0 ± 7.6 and 69.3 ± 15.6 letters (p = 0.509). VA remained stable (p = 0.761 and 0.964) after 15.5 ± 3 and 15.1 ± 3.5 aflibercept injections (p = 0.244). At 24 months, dry macula was noted in 40 to 50% of the eyes (p = 0.620). Complete resolution of polyps was observed in 58% at 12 months and 92% at 24 months.
In patients with nAMD refractory to ranibizumab, aflibercept was effective at maintaining VA and closing numerous polyps. In half of the patients, dry macula was observed at 24 months.
描述雷珠单抗治疗无效转而使用阿柏西普的新生血管性年龄相关性黄斑变性（nAMD）患者的吲哚菁绿血管造影（ICGA）和视力（VA）结果。
本研究为前瞻性干预性病例系列。32例nAMD患者的32只眼在接受至少24个月雷珠单抗治疗后反应不佳，转而使用阿柏西普。20只眼为I型脉络膜新生血管（CNV组），12只眼为息肉样脉络膜血管病变（PCV组）。在初始给予三个月一次的阿柏西普负荷剂量注射后，治疗继续采用按需延长治疗方案。在首次注射阿柏西普前（基线）、12个月和24个月后进行ICGA检查。记录的变量包括：息肉闭合情况和病变面积、视力、阿柏西普注射次数、干性黄斑和色素上皮脱离。
CNV组和PCV组分别记录到以下均值：雷珠单抗注射次数20.4±11.2次和22.4±12.9次（p = 0.740）；基线视力（阿柏西普治疗前）分别为73.2±9.1和70.3±13.7字母（p = 0.654）；最终视力分别为73.0±7.6和69.3±15.6字母（p = 0.509）。在分别接受15.5±3次和15.1±3.5次阿柏西普注射后，视力保持稳定（p = 0.761和0.964）（p = 0.244）。在24个月时，40%至50%的眼出现干性黄斑（p = 0.620）。在12个月时观察到58%的息肉完全消退，在24个月时为92%。
在雷珠单抗治疗无效的nAMD患者中，阿柏西普在维持视力和闭合大量息肉方面有效。在一半的患者中，在24个月时观察到干性黄斑。
