新生血管性年龄相关性黄斑变性患者基线视力与抗血管内皮生长因子治疗结果的相关性
Correlation of Baseline Visual Acuity with Outcomes of Treatment with Anti-VEGF in Neovascular Age-Related Macular Degeneration.
作者信息
Veluswamy Balaji, Lee Andy, Mirza Rukhsana G, Gill Manjot K
机构信息
Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
出版信息
Clin Ophthalmol. 2020 Jun 10;14:1565-1572. doi: 10.2147/OPTH.S256009. eCollection 2020.
PURPOSE
Neovascular age-related macular degeneration (nv-AMD) is the leading cause of blindness in individuals 55 years and older. The advent of anti-vascular endothelial growth factor (anti-VEGF) therapy has greatly altered the visual acuity (VA) prognosis in these patients. While many studies have described treatment outcomes, few have explored the impact of early detection on VA outcomes.
PATIENTS AND METHODS
This retrospective cohort study consisted of treatment-naïve eyes with nv-AMD (ICD9 diagnosis code 362.52) that were treated with bevacizumab, ranibizumab, and aflibercept by four physician investigators in a large urban tertiary center from March 2008 to October 2015. Eyes were categorized by baseline VA into good (20/50 or better), intermediate (20/50-20/200), and poor (20/200 or worse) initial VA. VA and optical coherence tomography (OCT) findings were evaluated throughout the treatment period.
RESULTS
224 eyes were evaluated. Of eyes with good, intermediate, and poor initial VA, 14.1%, 37.2%, and 58.3% showed an increase in 2 or more lines of vision on LogMAR, respectively [p < 0.001], while 71.8%, 40.7%, and 16.7% of eyes had a final VA of 20/50 or better, respectively [p < 0.001]. Average final Snellen VA in eyes with good, intermediate, and poor initial VA was 20/47, 20/96, and 20/277, respectively. Change in VA for good, intermediate, and poor initial VA groups was ΔLogMAR of +0.117, +0.041, and -0.230, respectively. Of eyes with good, intermediate, and poor baseline VA, 42.3%, 20.9%, and 20.0%, respectively, showed resolution of fluid on OCT [p = 0.003].
CONCLUSION
Patients with good initial VA were more likely to maintain good vision and show resolution of fluid on OCT through follow-up. Patients with poor initial VA tended to gain more vision, however, had poorer final VA. This underscores the importance of early detection and treatment of nv-AMD in maintaining superior outcomes.
目的
新生血管性年龄相关性黄斑变性（nv-AMD）是55岁及以上人群失明的主要原因。抗血管内皮生长因子（anti-VEGF）疗法的出现极大地改变了这些患者的视力（VA）预后。虽然许多研究描述了治疗结果，但很少有研究探讨早期检测对VA结果的影响。
患者和方法
这项回顾性队列研究纳入了2008年3月至2015年10月在一家大型城市三级中心由四位医生研究者用贝伐单抗、雷珠单抗和阿柏西普治疗的初治nv-AMD眼（ICD9诊断代码362.52）。根据基线VA将眼部分为初始VA良好（20/50或更好）、中等（20/50 - 20/200）和较差（20/200或更差）。在整个治疗期间评估VA和光学相干断层扫描（OCT）结果。
结果
共评估了224只眼。初始VA良好、中等和较差的眼中，分别有14.1%、37.2%和58.3%在LogMAR视力表上视力提高了2行或更多行[p < 0.001]，而最终VA为20/50或更好的眼分别为71.8%、40.7%和16.7%[p < 0.001]。初始VA良好、中等和较差的眼的平均最终Snellen视力分别为20/47、20/96和20/277。初始VA良好、中等和较差组的VA变化的ΔLogMAR分别为+0.117、+0.041和 - 0.230。基线VA良好、中等和较差的眼中，分别有42.3%、20.9%和20.0%在OCT上显示积液消退[p = 0.003]。
结论
初始VA良好的患者更有可能通过随访保持良好视力并在OCT上显示积液消退。初始VA较差患者视力提高幅度往往更大，但最终VA较差。这强调了早期检测和治疗nv-AMD以维持更好结果的重要性。
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