Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0125, Japan.
Jpn J Ophthalmol. 2020 Jul;64(4):338-345. doi: 10.1007/s10384-020-00745-0. Epub 2020 May 24.
To evaluate the development and rate of growth in macular atrophy after intravitreal injections of aflibercept (IVAs) for neovascular age-related macular degeneration (AMD) over a 2-year period.
Retrospective, interventional, consecutive case series.
This study included 94 eyes of 92 patients with treatment-naïve AMD involving the foveal center treated with IVAs at 3 university hospitals in Japan. The patients underwent IVAs bimonthly after 3 initial monthly doses in the first year. The protocol was converted to a treat-and-extend regimen in the second year. The incidence and growth rate of macular atrophy were quantified based on hypoautofluorescence detected by fundus autofluorescence images. Additionally, possible background factors related to the development and rate of growth of macular atrophy were investigated.
Of 94 eyes, 39 (41.5%) had typical AMD and 55 (58.5%) had polypoidal choroidal vasculopathy. Ten eyes (10.6%) had macular atrophy at the baseline. Of the remaining 84 eyes, 14 (16.7%) had developed new macular atrophy at 2 years, the square root of the growth rate of atrophy was 0.52 mm/year. In multivariate analyses, a poorer best-corrected visual acuity (P = 0.01) and the presence of intraretinal fluid (P = 0.04) at baseline were found to be the independent predictors for the development of macular atrophy. No factors were found that were significantly related to the growth rate of the macular atrophy.
Our study determined the incidence and rate of growth of macular atrophy after IVAs for neovascular AMD in clinical settings. Eyes with vision reduction and intraretinal fluid at the baseline develop macular atrophy more frequently after IVAs for neovascular AMD.
评估 2 年内玻璃体内注射阿柏西普（IVAs）治疗新生血管性年龄相关性黄斑变性（AMD）后的黄斑萎缩的发展和增长速度。
回顾性、干预性、连续病例系列。
本研究纳入了日本 3 所大学医院的 92 例 94 只治疗初发 AMD 累及中心凹的患眼，这些患者接受了每月 3 次的初始治疗，共 3 次，之后每 2 个月进行 1 次 IVAs 治疗。第二年，方案改为按需治疗和延长治疗。通过眼底自发荧光图像检测到的低自发荧光来量化黄斑萎缩的发生率和增长速度。此外，还研究了与黄斑萎缩的发展和增长速度相关的可能背景因素。
94 只眼中，39 只（41.5%）为典型 AMD，55 只（58.5%）为息肉样脉络膜血管病变。基线时有 10 只眼（10.6%）存在黄斑萎缩。在其余 84 只眼中，2 年后有 14 只眼（16.7%）新出现黄斑萎缩，萎缩的平方根增长率为 0.52mm/年。多变量分析发现，基线时最佳矫正视力较差（P=0.01）和存在视网膜内液（P=0.04）是黄斑萎缩发展的独立预测因素。未发现与黄斑萎缩增长率显著相关的因素。
本研究确定了新生血管性 AMD 玻璃体内注射后黄斑萎缩的发生率和增长速度。基线时视力下降和视网膜内液存在的患眼在接受新生血管性 AMD 的 IVAs 治疗后更容易发生黄斑萎缩。
