Eshtiaghi Arshia, Issa Mariam, Popovic Marko M, Muni Rajeev H, Kertes Peter J
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Retina. 2021 Dec 1;41(12):2424-2435. doi: 10.1097/IAE.0000000000003207.
Geographic atrophy (GA) is a complication of advanced neovascular age-related macular degeneration that can lead to permanent vision loss. We sought to estimate the incidence and progression of GA after intravitreal injections of antivascular endothelial growth factor agents in eyes with neovascular age-related macular degeneration.
Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were searched from inception to May 2020. Included studies reported on the progression or development of GA in eyes with neovascular age-related macular degeneration after antivascular endothelial growth factor therapy.
Thirty-one articles and 4,609 study eyes (4,501 patients) were included. Eyes received a mean of 17.7 injections over 35.2 months. The prevalence of GA at baseline was 9.7%. The pooled incidence of GA was 30.5% at the end of follow-up. There was a positive, moderate linear correlation between the mean total number of injections and GA incidence at the final follow-up (R2 = 0.30; P = 0.01). Monthly treatment was associated with a significantly higher risk for GA development relative to pro re nata (relative risk = 1.40, 95% confidence interval = [1.21-1.61], P < 0.001). Risk factors for GA development included GA in the fellow eye, retinal angiomatous proliferation, drusen, and reticular pseudodrusen.
We found an association between the frequency and number of treatments with antivascular endothelial growth factor agents and the development of GA in neovascular age-related macular degeneration. Future studies should clarify risk factors, population characteristics, and relative contributions of treatment and disease progression on GA development in this context.
地图样萎缩（GA）是晚期新生血管性年龄相关性黄斑变性的一种并发症，可导致永久性视力丧失。我们试图评估在新生血管性年龄相关性黄斑变性患者眼内注射抗血管内皮生长因子药物后GA的发生率和进展情况。
检索Ovid MEDLINE、EMBASE和Cochrane CENTRAL数据库，检索时间从建库至2020年5月。纳入的研究报告了抗血管内皮生长因子治疗后新生血管性年龄相关性黄斑变性患者眼中GA的进展或发生情况。
纳入31篇文章和4609只研究眼（4501例患者）。这些眼睛在35.2个月内平均接受了17.7次注射。基线时GA的患病率为9.7%。随访结束时GA的合并发生率为30.5%。在最后一次随访时，注射的平均总数与GA发生率之间存在正性、中度线性相关性（R2 = 0.30；P = 0.01）。相对于按需治疗，每月治疗与GA发生风险显著升高相关（相对风险 = 1.40，95%置信区间 = [1.21 - 1.61]，P < 0.001）。GA发生的危险因素包括对侧眼的GA、视网膜血管瘤样增生、玻璃膜疣和网状假性玻璃膜疣。
我们发现抗血管内皮生长因子药物的治疗频率和次数与新生血管性年龄相关性黄斑变性中GA的发生之间存在关联。未来的研究应阐明在这种情况下GA发生的危险因素、人群特征以及治疗和疾病进展的相对作用。
