初始玻璃体内组织型纤溶酶原激活物和气体注射对与年龄相关性黄斑变性相关的黄斑下出血患者视力改善的影响。
The effect of initial intravitreal tissue plasminogen activator and gas injection on vision improvement in patients with submacular haemorrhage associated with age-related macular degeneration.
机构信息
Department of Ophthalmology, College of Medicine, Kosin University, Busan, South Korea.
Rhee's Eye Hospital, Daejeon, South Korea.
出版信息
Eye (Lond). 2021 Nov;35(11):3064-3070. doi: 10.1038/s41433-020-01383-z. Epub 2021 Jan 9.
PURPOSE
To compare visual improvements between initial intravitreal t-PA with gas injection before anti-vascular endothelial growth factor (VEGF) and anti-VEGF injection monotherapy for submacular haemorrhage (SMH) associated with age-related macular degeneration (AMD).
METHODS
We retrospectively reviewed medical records of naive patients treated with intravitreal t-PA with gas injection before anti-VEGF (Group 1) or only with intravitreal anti-VEGF injection (Group 2) for SMH [disc area (DA) ≥ 2] associated with AMD from two institutions. Both groups received 3 monthly loads of anti-VEGF injections followed by injections as needed for AMD treatment. Changes in best-corrected visual acuity (BCVA, logMAR) between the initial visit and after 6 months of treatment were compared between two groups.
RESULTS
A total of 82 patients were enroled. Of these, 32 patients and 50 patients were grouped in Groups 1 and 2, respectively. The mean change in BCVA over 6 months for Group 1 was -0.52 ± 0.88, which was significantly larger (p = 0.044) than the mean change for Group 2 (-0.15 ± 0.58). We compared visual improvements between the two groups based on the following SMH size categories: ≤5, >5, and ≤15, and >15 DA. When the SMH size was ≤5, or >5 and ≤15 DA, the mean change in BCVA was larger for Group 1 than for Group 2, but this difference was not significant. When SMH size was >15 DA, Group 1 patients exhibited a mean visual improvement of -0.79 ± 0.80, which was significantly greater (p = 0.029) than that of Group 2 (-0.06 ± 0.67).
CONCLUSIONS
Patients that were primarily treated for SMH associated with AMD using t-PA and gas injection (followed by anti-VEGF injection) exhibited better visual improvement than those treated with anti-VEGF monotherapy, especially in patients exhibiting larger SMH sizes (>15 DA) at the initial visit.
目的
比较初始玻璃体内 t-PA 联合注气与抗血管内皮生长因子（VEGF）治疗对与年龄相关性黄斑变性（AMD）相关的黄斑下出血（SMH）的视力改善效果。
方法
我们回顾性分析了来自两个机构的使用玻璃体内 t-PA 联合注气（1 组）或单纯玻璃体内抗 VEGF 注射（2 组）治疗与 AMD 相关的 SMH[盘区面积（DA）≥2]的初治患者的病历。两组均接受 3 个负荷剂量的抗 VEGF 注射，随后根据 AMD 治疗需要进行注射。比较两组间初始就诊至治疗 6 个月时最佳矫正视力（BCVA，logMAR）的变化。
结果
共纳入 82 例患者，其中 32 例和 50 例患者分别纳入 1 组和 2 组。1 组 BCVA 在 6 个月时的平均变化为-0.52±0.88，显著大于 2 组的-0.15±0.58（p=0.044）。我们根据以下 SMH 大小类别比较了两组间的视力改善情况：≤5、>5 和≤15、>15 DA。当 SMH 大小为≤5 或>5 和≤15 DA 时，1 组 BCVA 的平均变化大于 2 组，但差异无统计学意义。当 SMH 大小>15 DA 时，1 组患者的平均视力改善为-0.79±0.80，显著大于 2 组（-0.06±0.67，p=0.029）。
结论
与仅接受抗 VEGF 治疗的患者相比，主要使用 t-PA 和注气治疗（随后接受抗 VEGF 治疗）的与 AMD 相关的 SMH 患者的视力改善效果更好，尤其是在初始就诊时 SMH 较大（>15 DA）的患者。
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