Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Ophthalmology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Br J Ophthalmol. 2021 Dec;105(12):1688-1695. doi: 10.1136/bjophthalmol-2020-317161. Epub 2020 Oct 3.
To describe 10-year trends in visual outcomes, anatomical outcomes and treatment burden of patients receiving antivascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD).
Retrospective cohort study of treatment-naïve, first-affected eyes with nAMD started on ranibizumab before January 1, 2009. The primary outcome was time to best-corrected visual acuity (BCVA) falling ≤35 ETDRS letters after initiating anti-VEGF therapy. Secondary outcomes included time to BCVA reaching ≥70 letters, proportion of eyes with BCVA ≥70 and ≤35 letters in 10 years, mean trend of BCVA and central retinal thickness over 10 years, and mean number of injections.
For our cohort of 103 patients, Kaplan-Meier analyses demonstrated median time to BCVA reaching ≤35 and ≥70 letters were 37.8 (95% CI 22.2 to 65.1) and 8.3 (95% CI 4.8 to 20.9) months after commencing anti-VEGF therapy, respectively. At the final follow-up, BCVA was ≤35 letters and ≥70 letters in 41.1% and 21%, respectively, in first-affected eyes, while this was the case for 5.4% and 48.2%, respectively, in a patient's better-seeing eye. Mean injection number was 37.0±24.2 per eye and 53.6±30.1 at patient level (63.1% of patients required injections in both eyes).
The chronicity of nAMD disease and its management highlights the importance of long-term visual prognosis. Our analyses suggest that one in five patients will retain good vision (BCVA ≥70 ETDRS letters) in the first-affected eye at 10 years after starting anti-VEGF treatment; yet, one in two patients will have good vision in their better-seeing eye. Moreover, our data suggest that early treatment of nAMD is associated with better visual outcomes.
描述接受抗血管内皮生长因子（抗-VEGF）治疗的新生血管性年龄相关性黄斑变性（nAMD）患者的 10 年视觉结果、解剖学结果和治疗负担的趋势。
回顾性队列研究，纳入 2009 年 1 月 1 日前开始接受雷珠单抗治疗的初发、单眼 nAMD 患者。主要结局是在开始抗 VEGF 治疗后最佳矫正视力（BCVA）下降至≤35 ETDRS 字母的时间。次要结局包括 BCVA 达到≥70 字母的时间、10 年内 BCVA 达到≥70 和≤35 字母的比例、10 年内 BCVA 和中心视网膜厚度的平均趋势以及平均注射次数。
对于我们的 103 名患者队列，Kaplan-Meier 分析显示，开始抗 VEGF 治疗后 37.8（95%CI 22.2 至 65.1）和 8.3（95%CI 4.8 至 20.9）个月时 BCVA 分别达到≤35 和≥70 字母的中位数时间。在最终随访时，初发眼 BCVA 分别为≤35 字母和≥70 字母的比例分别为 41.1%和 21%，而对侧眼则分别为 5.4%和 48.2%。平均注射次数为每只眼 37.0±24.2 次和患者水平的 53.6±30.1 次（63.1%的患者双眼均需要注射）。
nAMD 疾病的慢性病程及其管理突出了长期视觉预后的重要性。我们的分析表明，开始抗 VEGF 治疗后 10 年，每 5 名患者中就有 1 名患者初发眼保留良好视力（BCVA≥70 ETDRS 字母）；然而，每 2 名患者中就有 1 名患者对侧眼保留良好视力。此外，我们的数据表明，早期治疗 nAMD 与更好的视觉结果相关。
