基线视力为20/60或更佳的眼睛中，玻璃体腔内药物治疗新生血管性年龄相关性黄斑变性的五年结果。
Five-year outcomes of intravitreal drug therapy for neovascular age-related macular degeneration in eyes with baseline vision 20/60 or better.
作者信息
Khanani Arshad M, Gahn Greggory M, Koci Micaela M, Dang Jonathan M, Brown Sandra M, Hill Lauren F
机构信息
Sierra Eye Associates, Reno, NV, USA,
School of Medicine, University of Nevada, Reno, NV, USA.
出版信息
Clin Ophthalmol. 2019 Feb 13;13:347-351. doi: 10.2147/OPTH.S191170. eCollection 2019.
OBJECTIVE
To assess outcomes in treatment-naive eyes with neovascular age-related macular degeneration (nAMD) and good baseline visual acuity (VA) treated using a treat-and-extend (T&E) regimen with intravitreal aflibercept, ranibizumab, or bevacizumab.
DESIGN
Single center, retrospective, observational case series.
PARTICIPANTS
Ninety-one patients (93 eyes) with nAMD and baseline VA ≥20/60 followed for ≥1 year after the first intravitreal injection. Minimum of 6 (first year) and 3 (subsequent years) and maximum of 12 injections per 12 calendar months.
INTERVENTION
Intravitreal aflibercept 2.0 mg, ranibizumab 0.5 mg, or bevacizumab 1.25 mg. Three monthly injections. Treatment interval extended in 2-week increments after resolution of macular edema and reduced in 2-week increments if edema recurred; maximum interval of 12 weeks. Medication changed if edema recurred during and persisted after three monthly injections of original agent.
MAIN OUTCOME MEASURES
VA maintenance over time. Total number of injections received by year of treatment.
RESULTS
Ninety-three eyes were analyzed. Pretreatment VA was 20/20-20/25 (N=16), 20/30-20/40 (N=47), and 20/50-20/60 (N=30). Mean follow-up was 3.2 years. Follow-up by year was 93, 73, 65, 44, and 26 eyes for years 1-5, respectively. Mean number of injections during years 1-5 was 7.9, 5.9, 5.6, 5.9, and 6.0, respectively; mode number of injections was 7, 5, 3, 6, and 4, respectively. For years 1-5, percent of all eyes at or above baseline was 70%, 66%, 65%, 59%, and 58%, respectively; percent ≥20/60 was 86%, 88%, 86%, 84%, and 77% for years 1-5. For eyes with baseline VA ≥20/40, percent of eyes at or above baseline was 83%, 82%, 81%, 68% and 76% for years 1-5, respectively.
CONCLUSION
Using a T&E intravitreal injection protocol, more than 75% of treatment-naive eyes with nAMD and baseline VA ≥20/60 can maintain VA ≥20/60 over 5 years.
目的
评估初治的新生血管性年龄相关性黄斑变性（nAMD）且基线视力（VA）良好的患眼，采用玻璃体内注射阿柏西普、雷珠单抗或贝伐单抗的治疗并延长（T&E）方案后的治疗效果。
设计
单中心、回顾性、观察性病例系列研究。
参与者
91例（93只眼）nAMD患者，基线VA≥20/60，在首次玻璃体内注射后随访≥1年。每12个日历月最少注射6次（第1年）和3次（后续年份），最多注射12次。
干预
玻璃体内注射2.0mg阿柏西普、0.5mg雷珠单抗或1.25mg贝伐单抗。每3个月注射一次。黄斑水肿消退后治疗间隔以2周为增量延长，若水肿复发则以2周为增量缩短；最大间隔为12周。如果在最初药物每月注射3次期间及之后水肿复发，则更换药物。
主要观察指标
随时间推移的视力维持情况。每年接受注射的总数。
结果
分析了93只眼。治疗前视力为20/20 - 20/25（n = 16）、20/30 - 20/40（n = 47）和20/50 - 20/60（n = 30）。平均随访3.2年。第1 - 5年每年的随访眼数分别为93、73、65、44和26只。第1 - 5年平均注射次数分别为7.9、5.9、5.6、5.9和6.0次；注射次数众数分别为7、5、3、6和4次。第1 - 5年，所有眼达到或高于基线的百分比分别为70%、
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