Wang Zongyi, Li Mengyang, Yao Yuou, Hu Jie, Tang Jiyang, Tang Ran, Piao Zhenyu, Qu Jinfeng
Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China.
J Ophthalmol. 2020 Sep 7;2020:9340356. doi: 10.1155/2020/9340356. eCollection 2020.
To study the short-term anatomical and functional outcomes in patients with neovascular age-related macular degeneration (nAMD) who were previously treated with conbercept and switched to ranibizumab or bevacizumab due to persistent activity.
This retrospective single-arm study included nAMD patients who were followed up for at least three months after switching from at least 3 monthly intravitreal conbercept injections to bevacizumab or ranibizumab for persistent choroidal neovascularization (CNV) activity. The demographic data, treatments, best-corrected visual acuity (BCVA), central macular thickness (CMT), and the height of pigmented epithelial detachment (PED) before and after switching were recorded and analyzed.
A total of 64 eyes of 64 patients were included with a mean follow-up of 9.6 ± 3.0 months. The average number of injections of conbercept was 3.6 ± 0.8 (range, 3-5) before switching. 18 eyes were switched to bevacizumab, and the other 46 eyes were switched to ranibizumab. After switching, mean BCVA slowly improved from 0.73 ± 0.48 to 0.64 ± 0.41 (=0.0132) at one month after the last intravitreal injection of ranibizumab or bevacizumab during the mean follow-up of 4.4 ± 2.0 months. One month after switching, the mean CMT decreased significantly from 294.9 ± 121.8 m to 230.9 ± 107.0 m ( < 0.0001) and kept stable during the follow-up. There was a significant reduction of maximum PED height (mPEDH) at the first month after switching (from 384.3 ± 340.3 m to 287.2 ± 245.2 m, =0.0018) and kept stable during the follow-up. The mean PED height at foveal center (cPEDH) showed a regression over time after switching (from 169.3 ± 230.6 m to 130.5 ± 180.2 m, =0.0227) and also kept stable during the follow-up. The proportion of patients with IRF was slightly increased but not statistically significant before switching. After switching, this proportion decreased significantly from 96.9% to 81.3% at one month after the first intravitreal injection of ranibizumab or bevacizumab (=0.0086). The proportion of patients with SRF did not change significantly before and after switching. The mean decrease of mPEDH and cPEDH at the last follow-up after switching was significantly larger in the IVR subgroup than in the IVB subgroup (=0.023 and 0.010).
Our results indicate that switching from intravitreal conbercept injections to bevacizumab or ranibizumab can lead to significant improvement of CMT, PED, and IRF and slight improvement of BCVA in a short period of time for persistent nAMD patients.
研究既往接受康柏西普治疗，因病情持续活动而改用雷珠单抗或贝伐单抗的新生血管性年龄相关性黄斑变性（nAMD）患者的短期解剖学和功能结局。
这项回顾性单臂研究纳入了nAMD患者，这些患者在至少3次每月玻璃体内注射康柏西普后，因脉络膜新生血管（CNV）持续活动而改用贝伐单抗或雷珠单抗，并进行了至少3个月的随访。记录并分析了患者的人口统计学数据、治疗情况、最佳矫正视力（BCVA）、中心黄斑厚度（CMT）以及改用药物前后色素上皮脱离（PED）的高度。
共纳入64例患者的64只眼，平均随访时间为9.6±3.0个月。改用药物前，康柏西普的平均注射次数为3.6±0.8次（范围3 - 5次）。18只眼改用贝伐单抗，另外46只眼改用雷珠单抗。改用药物后，在平均4.4±2.0个月的随访期间，末次玻璃体内注射雷珠单抗或贝伐单抗后1个月，平均BCVA从0.73±0.48缓慢改善至0.64±0.41（P = 0.0132）。改用药物1个月后，平均CMT从294.9±21.8μm显著降至230.9±107.0μm（P < 0.0001），并在随访期间保持稳定。改用药物后第1个月，最大PED高度（mPEDH）显著降低（从384.3±340.3μm降至27.2±245.2μm，P = 0.0018），并在随访期间保持稳定。黄斑中心凹处的平均PED高度（cPEDH）在改用药物后随时间推移呈下降趋势（从169.3±230.6μm降至130.5±180.2μm，P = 0.0227），并在随访期间保持稳定。改用药物前，视网膜内液（IRF）患者比例略有增加，但无统计学意义。改用药物后，首次玻璃体内注射雷珠单抗或贝伐单抗后1个月，该比例从96.9%显著降至81.3%（P = 0.0086）。视网膜下液（SRF）患者比例在改用药物前后无显著变化。改用药物后末次随访时，玻璃体内注射雷珠单抗（IVR）亚组的mPEDH和cPEDH平均降低幅度显著大于玻璃体内注射贝伐单抗（IVB）亚组（P = 0.023和0.010）。
我们的结果表明，对于持续性nAMD患者，从玻璃体内注射康柏西普改用贝伐单抗或雷珠单抗可在短时间内使CMT、PED和IRF得到显著改善，BCVA略有改善。
