Indiana University School of Medicine, Indianapolis, Indiana.
Retina Health Institute, Elgin, Illinois.
Ophthalmol Retina. 2022 Sep;6(9):796-806. doi: 10.1016/j.oret.2022.03.021. Epub 2022 Apr 2.
The clinical practice visual acuity (VA) outcomes of anti-VEGF therapy for up to 5 years were assessed in patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), branch retinal vein occlusion-related macular edema (BRVO-ME), and central retinal vein occlusion-related macular edema (CRVO-ME).
A retrospective analysis was performed using the Vestrum Health Retina Database.
Treatment-naive patients with nAMD, DME, BRVO-ME, or CRVO-ME who received anti-VEGF injections between 2014 and 2019 and had follow-up data for ≥12 months.
Data on age, sex, the number of anti-VEGF treatments, and VA were analyzed.
Mean VA change up to 3 years (BRVO-ME and CRVO-ME) and 5 years (nAMD and DME).
At 1, 3, and 5 years, in 67 666, 21 305, and 5208 eyes with nAMD, after a mean of 7.6, 19.5, and 32 injections, there was a mean change of +3.1, -0.2, and -2.2 letters, respectively. At 1, 3, and 5 years, in 40 832, 7728, and 1192 eyes with DME, after a mean of 6.2, 15.4, and 26.0 injections, there was a mean change of +4.7, +3.3, and +3.1 letters, respectively. At 1 and 3 years, in 12 451 and 3027 eyes with BRVO-ME, after a mean of 7.1 and 18.2 injections, there was a mean change of +9.5 and +7.7 letters, respectively. At 1 and 3 years, in 9298 and 2264 eyes with CRVO-ME, after a mean of 7.3 and 18.8 injections, there was a mean change of +8.3 and +6.0 letters, respectively (P < 0.01 for all VA changes of > 1 letter). In all 4 conditions, the mean VA increased with the mean number of anti-VEGF injections, eyes with a baseline VA of 20/40 or better tended to lose VA, and eyes with progressively worse baseline VA experienced a progressively greater VA gain at 3 years.
In practice, patients with nAMD, DME, BRVO-ME, and CRVO-ME showed limited visual outcomes, with patients with nAMD tending to lose VA at 3 and 5 years. Across all 4 disorders, the mean change in VA correlated with treatment intensity at 1, 3, and 5 years. Patients with better baseline VA are more vulnerable to vision loss.
评估抗血管内皮生长因子治疗长达 5 年的新生血管性年龄相关性黄斑变性（nAMD）、糖尿病性黄斑水肿（DME）、分支视网膜静脉阻塞相关性黄斑水肿（BRVO-ME）和中央性视网膜静脉阻塞相关性黄斑水肿（CRVO-ME）患者的临床实践视力（VA）结果。
使用 Vestrum Health 视网膜数据库进行回顾性分析。
2014 年至 2019 年间接受抗血管内皮生长因子注射且随访数据≥12 个月的治疗初治 nAMD、DME、BRVO-ME 或 CRVO-ME 患者。
分析年龄、性别、抗血管内皮生长因子治疗次数和 VA 数据。
nAMD 和 DME 患者的 3 年（BRVO-ME 和 CRVO-ME）和 5 年（nAMD 和 DME）平均 VA 变化。
在 67666 只 nAMD 眼、21305 只 DME 眼和 5208 只眼中，平均分别接受 7.6、19.5 和 32 次注射后，在 1、3 和 5 年时，VA 平均分别增加了+3.1、-0.2 和-2.2 个字母。在 40832 只 DME 眼、7728 只 DME 眼和 1192 只眼中，平均分别接受 6.2、15.4 和 26.0 次注射后，在 1、3 和 5 年时，VA 平均分别增加了+4.7、+3.3 和+3.1 个字母。在 12451 只 BRVO-ME 眼和 3027 只 BRVO-ME 眼中，分别接受 7.1 和 18.2 次注射后，在 1 和 3 年时，VA 平均分别增加了+9.5 和+7.7 个字母。在 9298 只 CRVO-ME 眼和 2264 只 CRVO-ME 眼中，分别接受 7.3 和 18.8 次注射后，在 1 和 3 年时，VA 平均分别增加了+8.3 和+6.0 个字母（所有>1 个字母的 VA 变化均为 P <0.01）。在所有 4 种情况下，VA 随抗血管内皮生长因子注射次数的增加而增加，基线 VA 为 20/40 或更好的眼往往会失去 VA，而基线 VA 逐渐恶化的眼在 3 年内 VA 增益逐渐增加。
在实践中，nAMD、DME、BRVO-ME 和 CRVO-ME 患者的视力结果有限，nAMD 患者在 3 年和 5 年时往往会失去 VA。在所有 4 种疾病中，VA 的平均变化与 1、3 和 5 年的治疗强度相关。基线 VA 较好的患者更容易出现视力丧失。
