Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia.
Br J Ophthalmol. 2020 Aug;104(8):1052-1056. doi: 10.1136/bjophthalmol-2019-315257. Epub 2019 Nov 19.
There is still no established treatment regimen for eyes with inflammatory choroidal neovascularisation (iCNV) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. This study compared the 24-month outcomes of two treatment regimens of anti-VEGF injections in eyes with iCNV.
Eyes with iCNV treated with anti-VEGF injections were divided into two groups: eyes treated with a loading phase of 3 monthly injections and then re-treated as needed (LOADING group) and eyes treated as needed from the beginning (PRN group). Visual acuity (VA), number of injections and iCNV recurrences at 24 months were compared between the groups.
Eighty-two eyes were included, 42 in the LOADING and 40 in the PRN group. Baseline VA (mean(SD)) was 57.3 (15.8) letters in the LOADING vs 60.7 (15.6) letters in the PRN group (p=0.32). The VA (mean (95% CI)) increased at 3 months (+14.8 (10.6 to 18.9) and +11.2 (6.4 to 16) letters in the LOADING and PRN group, respectively) and remained significantly higher than baseline over the entire follow-up in both groups (all p<0.001). At 24 months, there was no difference in VA between the LOADING and PRN group (72.3 (14.0) vs 74.7 (11.3) letters, p=0.36) but the LOADING group received significantly more injections (median (Q1-Q3)) than the PRN (4.5 (3-7) vs 2.5 (2-3.2), p<0.0001). The iCNV recurrences were similar in both groups.
iCNV responded well to anti-VEGF with significant and sustained VA improvement. The loading phase did not confer any advantage in terms of outcomes. PRN regimen from the beginning was as effective as more intensive treatment.
对于接受玻璃体内抗血管内皮生长因子（VEGF）注射治疗的炎症性脉络膜新生血管（iCNV）眼，目前尚无既定的治疗方案。本研究比较了两种抗 VEGF 注射治疗方案在 iCNV 眼中的 24 个月结果。
将接受抗 VEGF 注射治疗的 iCNV 眼分为两组：接受 3 个月负荷期注射，然后按需再次治疗（LOADING 组）和从一开始按需治疗（PRN 组）。比较两组 24 个月时视力（VA）、注射次数和 iCNV 复发情况。
共纳入 82 只眼，LOADING 组 42 只，PRN 组 40 只。LOADING 组的基线 VA（平均值（标准差））为 57.3（15.8）个字母，PRN 组为 60.7（15.6）个字母（p=0.32）。VA（平均值（95%置信区间））在 3 个月时增加（LOADING 组和 PRN 组分别增加+14.8（10.6 至 18.9）和+11.2（6.4 至 16）个字母），并且在整个随访期间均显著高于基线（均 p<0.001）。24 个月时，LOADING 组和 PRN 组之间的 VA 无差异（72.3（14.0）与 74.7（11.3）个字母，p=0.36），但 LOADING 组的注射次数明显多于 PRN 组（中位数（Q1-Q3））（4.5（3-7）与 2.5（2-3.2），p<0.0001）。两组 iCNV 复发情况相似。
iCNV 对抗 VEGF 反应良好，VA 显著且持续改善。负荷期在结果方面没有任何优势。从一开始采用 PRN 方案与更密集的治疗同样有效。
