Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France; UMR-CNRS 5510 Matéis, Villeurbane, France.
Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France.
Ophthalmol Retina. 2022 Feb;6(2):109-115. doi: 10.1016/j.oret.2021.04.015. Epub 2021 May 13.
To evaluate early predictive factors of visual loss in patients treated with anti-vascular endothelial growth factor (VEGF) injections under an as-needed regimen for neovascular age-related macular degeneration (AMD).
Post hoc analysis from the randomized controlled trial Groupe d'Evaluation Français Avastin versus Lucentis (GEFAL).
A total of 393 patients with neovascular AMD.
The present analysis is based on 1-year data from patients included in the study. Patients were separately categorized according to the best-corrected visual acuity (BCVA) change at 3 months and 1 year into 3 trajectories: (1) patients with no vision loss ≥5 letters at 3 months and 1 year (absence of loss ≥5 letters); (2) patients with no vision loss ≥5 letters at 3 months but loss ≥5 letters at 1 year (secondary loss ≥5 letters); and (3) patients with vision loss ≥5 letters at 3 months and 1 year (initial loss ≥5 letters).
The following factors were evaluated at baseline and 3 months: age, sex, BCVA, presence of fluid, central macular thickness, angiographic choroidal neovascularization (CNV) subtype, CNV area measured in disc area on fluorescein angiography, and number of intravitreal injections.
An absence of loss ≥5 letters was found in 225 patients (57.3%), a secondary loss ≥5 letters after 3 months was found in 109 patients (27.7%), and an initial loss ≥5 letters was found in 59 patients (15%). Baseline characteristics were comparable among the 3 groups except for the total CNV area, which was larger in the initial and secondary loss groups (P = 0.0412). At 3 months, a significant association was found between presence of subretinal fluid (SRF) (P = 0.0318) and vision loss ≥5 letters, and an even stronger significant association between the presence of intraretinal fluid (IRF) (P = 0.0066) and vision loss ≥5 letters.
In the present study, we found that a large CNV area at baseline was significantly associated with initial or secondary loss of visual acuity ≥5 letters despite anti-VEGF injection. The presence of fluid, both SRF and IRF, at 3 months was found in patients with poorer trajectories.
评估抗血管内皮生长因子（VEGF）治疗新生血管性年龄相关性黄斑变性（AMD）按需治疗方案下视力丧失的早期预测因素。
随机对照试验 Groupe d'Evaluation Français Avastin versus Lucentis（GEFAL）的事后分析。
共 393 名新生血管性 AMD 患者。
本分析基于纳入研究的患者 1 年数据。根据 3 个月和 1 年时最佳矫正视力（BCVA）的变化，患者分别归入以下 3 个轨迹：（1）3 个月和 1 年时无视力丧失≥5 个字母（无损失≥5 个字母）；（2）3 个月时无视力丧失≥5 个字母但 1 年时视力丧失≥5 个字母（继发损失≥5 个字母）；和（3）3 个月和 1 年时视力丧失≥5 个字母（初始损失≥5 个字母）。
基线和 3 个月时评估以下因素：年龄、性别、BCVA、液体存在、黄斑中心厚度、血管造影脉络膜新生血管（CNV）亚型、荧光素血管造影上盘面积测量的 CNV 面积和玻璃体内注射次数。
225 例患者（57.3%）无≥5 个字母的视力丧失，109 例患者（27.7%）3 个月后发生≥5 个字母的继发性视力丧失，59 例患者（15%）发生初始≥5 个字母的视力丧失。除总 CNV 面积外，3 组间基线特征无差异，初始和继发性视力丧失组的总 CNV 面积较大（P=0.0412）。3 个月时，存在视网膜下液（SRF）（P=0.0318）与视力丧失≥5 个字母显著相关，而存在视网膜内液（IRF）（P=0.0066）与视力丧失≥5 个字母的相关性更强。
在本研究中，我们发现基线时较大的 CNV 面积与抗 VEGF 注射后视力丧失≥5 个字母的初始或继发性丧失显著相关。3 个月时存在液体，无论是 SRF 还是 IRF，都与较差的轨迹相关。
Zotero 插件