Kikushima Wataru, Sakurada Yoichi, Sugiyama Atsushi, Yoneyama Seigo, Matsubara Mio, Fukuda Yoshiko, Kashiwagi Kenji
Department of Ophthalmology, University of Yamanashi, Chuo Yamanashi 409-3898, Japan.
J Clin Med. 2021 Mar 5;10(5):1098. doi: 10.3390/jcm10051098.
We investigated the long-term visual and anatomical outcomes of aflibercept monotherapy for exudative age-related macular degeneration (AMD) with good baseline best-corrected visual acuity (BCVA). A medical chart review was performed for 40 consecutive patients with baseline decimal BCVA ≥ 0.6 secondary to exudative AMD. Three monthly injections were administrated, and thereafter additional injection was performed if needed over 5 years. In total, 13 eyes with neovascular AMD (nAMD) and 27 eyes with polypoidal choroidal vasculopathy (PCV) were enrolled. In both groups, the mean BCVA significantly improved at the 12-month visit ( < 0.05). However, the significant improvement in BCVA disappeared at the 24-month visit, and the final mean BCVA was equivalent to that at baseline ( = 0.17 in the nAMD group and = 0.15 in the PCV group). The median number of injections required after the loading dose was 15.0 during the 5-year follow-up (nAMD:15.0 vs. PCV:15). During the study period, 37 (92.5%) eyes required retreatment(s). Cox regression analysis demonstrated that the protective allele of A69S was associated with a retreatment-free period from the initial injection ( = 0.041, repeated forward selection method). As-needed aflibercept monotherapy is a preferable treatment option for exudative AMD with good initial visual acuity regardless of nAMD or PCV during the 5-year study period.
我们研究了阿柏西普单药治疗基线最佳矫正视力（BCVA）良好的渗出性年龄相关性黄斑变性（AMD）的长期视觉和解剖学结果。对40例继发于渗出性AMD且基线十进制BCVA≥0.6的连续患者进行了病历回顾。每月注射3次，此后在5年期间根据需要进行额外注射。总共纳入了13只新生血管性AMD（nAMD）眼和27只息肉状脉络膜血管病变（PCV）眼。在两组中，12个月随访时平均BCVA均显著改善（<0.05）。然而，24个月随访时BCVA的显著改善消失，最终平均BCVA与基线时相当（nAMD组=0.17，PCV组=0.15）。在5年随访期间，负荷剂量后所需注射的中位数为15.0次（nAMD：15.0次 vs. PCV：15次）。在研究期间，37只眼（92.5%）需要再次治疗。Cox回归分析表明，A69S的保护性等位基因与从初次注射开始的无再次治疗期相关（=0.041，重复向前选择法）。在5年研究期间，对于初始视力良好的渗出性AMD，无论nAMD或PCV，按需使用阿柏西普单药治疗是一种较好的治疗选择。
