Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK.
IQVIA, Basel, Switzerland.
Eye (Lond). 2020 Dec;34(12):2249-2256. doi: 10.1038/s41433-020-0799-y. Epub 2020 Feb 17.
BACKGROUND/OBJECTIVES: To investigate the association between optical coherence tomography (OCT) markers of lesion activity and changes in visual acuity (VA) during anti-vascular endothelial growth factor (anti-VEGF) therapy of eyes diagnosed with neovascular age-related macular degeneration (nAMD); and how VA and OCT markers are considered in physicians' decision to retreat with anti-VEGFs.
SUBJECTS/METHODS: Retrospective, non-comparative, non-randomised cohort study involving electronic medical record data collected from 1190 patient eyes with nAMD diagnosis at two sites in the United Kingdom. Two sub-cohorts consisting of 321 and 301 eyes, respectively, were selected for analyses.
In 321 eyes, absence of IRF or SRF at ≥2 clinic visits resulted in a gain of five ETDRS letters from baseline, compared with two letters gained in eyes with <2 clinic visits with absence of IRF (p = 0.006) or SRF (p = 0.042). Anti-VEGF treatment was administered at 421 clinic visits, and 308 visits were without treatment. Comparing treatment visits with non-treatment visits, the maximum difference in frequency of OCT markers of lesion activity were for intraretinal fluid (IRF; 24% versus 5%) and subretinal fluid (SRF; 32% versus 5%). Pigment epithelial detachment (PED) was reported in 58% of treatment visits compared with 36% in non-treatment visits. VA loss was not a consistent trigger for retreatment as it was present in 63% of injection visits and in 49% of non-injection visits.
Retreatment decision making is most strongly influenced by the presence of IRF and SRF and less by the presence of PED or VA loss.
背景/目的：探讨在接受抗血管内皮生长因子（anti-VEGF）治疗的新生血管性年龄相关性黄斑变性（nAMD）患者中，光学相干断层扫描（OCT）病变活动性标志物与视力（VA）变化之间的相关性；以及在医生决定进行抗 VEGF 再治疗时，VA 和 OCT 标志物是如何被考虑的。
受试者/方法：这是一项回顾性、非对照、非随机队列研究，涉及在英国两个地点从电子病历数据中收集的 1190 只患有 nAMD 的患者眼的资料。分别选择了 321 只眼和 301 只眼的两个子队列进行分析。
在 321 只眼中，与两次就诊时 IRF 或 SRF ＜2 次的眼相比，≥2 次就诊时 IRF 或 SRF 缺失导致从基线开始视力提高了 5 个 ETDRS 字母，而 IRF（p=0.006）或 SRF（p=0.042）缺失的眼视力提高了 2 个字母。在 421 次就诊时进行了抗 VEGF 治疗，308 次就诊时未进行治疗。与非治疗就诊相比，病变活动性 OCT 标志物的最大差异见于视网膜内液（IRF；24%比 5%）和视网膜下液（SRF；32%比 5%）。与非治疗就诊相比，治疗就诊时报告了更多的色素上皮脱离（PED；58%比 36%）。VA 下降并不是再治疗的一个一致触发因素，因为它存在于 63%的注射就诊和 49%的非注射就诊中。
再治疗决策最主要受到 IRF 和 SRF 的影响，其次是 PED 或 VA 下降的存在。
