Barth T, Reiners M, Zeman F, Greslechner R, Helbig H, Gamulescu M-A
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
Zentrum für klinische Studien, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
Ophthalmologe. 2021 Dec;118(12):1255-1263. doi: 10.1007/s00347-020-01297-x. Epub 2020 Dec 15.
Neovascular age-related macular degeneration (nAMD) is the most frequent cause of pigment epithelial detachment (PED). In the clinical routine the treatment of fibrovascular PED (fPED) and serous vascularized PED (svPED) with intravitreal vascular endothelial growth factor (VEGF) inhibitors has a restricted prognosis.
There are limited data on the long-term outcome of PED under anti-VEGF therapy. Therefore, this study recorded the course of treated PEDs in nAMD eyes over a period of 5 years.
All eyes with fPED or svPED that underwent anti-VEGF medication between 2006 and 2015 were retrospectively analyzed regarding the clinical course and the morphology seen on optical coherence tomography (OCT). The inclusion criteria were the detection of a PED on OCT, the angiographic verification of nAMD, a documented clinical history over 5 years and a good image quality.
A total of 23 eyes from 22 patients met the inclusion criteria. After 5 years a significant deterioration of visual acuity (VA) was seen in all eyes (p = 0.007) and in the subgroup of cases with fPED (p = 0.045). In the eyes with svPED the decline of VA was not significant (p = 0.097). In the collective study group a statistically significant reduction of PED height (p = 0.006) and an increase of PED diameter was measured (p = 0.002). In the subgroup analysis the decrease of PED height and increase of PED diameter were significant for cases with svPED (p = 0.004, p = 0.013, respectively) but were not statistically significant for fPED eyes (height: p = 0.616; diameter: p = 0.097). In 17 (74%) eyes fibrosis or atrophy were seen on the final assessment of OCT images.
After 5 years of anti-VEGF therapy for nAMD-associated PED the VA declined in half of the eyes and the OCT showed an unfavorable morphology in 3/4 of the cases. The average number of visits and injections was distinctly lower than in clinical trials and other real-life analyses. In summary, we observed an undertreatment with a worse functional and anatomical outcome in our clinical routine compared to other studies.
新生血管性年龄相关性黄斑变性（nAMD）是色素上皮脱离（PED）最常见的原因。在临床实践中，玻璃体内注射血管内皮生长因子（VEGF）抑制剂治疗纤维血管性PED（fPED）和浆液性血管化PED（svPED）的预后有限。
关于抗VEGF治疗下PED的长期预后数据有限。因此，本研究记录了nAMD患眼中PED的治疗过程，为期5年。
回顾性分析2006年至2015年间接受抗VEGF药物治疗的所有fPED或svPED患眼的临床过程以及光学相干断层扫描（OCT）所见的形态。纳入标准为OCT检查发现PED、nAMD的血管造影证实、5年以上的记录临床病史以及良好的图像质量。
22例患者的23只眼符合纳入标准。5年后，所有患眼的视力（VA）均出现显著下降（p = 0.007），fPED病例亚组中也是如此（p = 0.045）。svPED患眼中VA的下降不显著（p = 0.097）。在总体研究组中，测量到PED高度有统计学意义的降低（p = 0.006），PED直径增加（p = 0.002）。亚组分析中，svPED病例的PED高度降低和PED直径增加具有显著性（分别为p = 0.004和p = 0.013），但fPED患眼无统计学意义（高度：p = 0.616；直径：p = 0.097）。在OCT图像的最终评估中，17只眼（74%）出现纤维化或萎缩。
nAMD相关性PED抗VEGF治疗5年后，半数患眼视力下降，四分之三的病例OCT显示形态不佳。就诊和注射的平均次数明显低于临床试验和其他实际分析。总之，与其他研究相比，我们在临床实践中观察到治疗不足，功能和解剖学结果更差。
