The University of Sydney, Sydney Medical School, Discipline of Ophthalmology and Eye Health, Save Sight Institute, Sydney, NSW, Australia.
Department of Ophthalmology, Dijon University Hospital, Dijon, France.
Eye (Lond). 2023 Apr;37(6):1145-1154. doi: 10.1038/s41433-022-02075-6. Epub 2022 May 4.
OBJECTIVES: To identify whether the outcomes of neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO) in routine clinical practice have changed over time. METHODS: We analysed 12-month outcomes in treatment-naïve eyes that started aflibercept or ranibizumab for nAMD (3802 eyes), DMO (975 eyes), Branch RVO (BRVO, 357 eyes), Central RVO (CRVO, 371 eyes) and Hemi-RVO (HRVO, 54 eyes) from 2015 and 2019 tracked in the prospectively designed observational Fight Retinal Blindness! Registry. RESULTS: The mean VA change at 12-month for each year between 2015 and 2019 remained stable or otherwise showed no discernible trends over time in eyes with nAMD (+3.3 to +6 letters), DMO (+3.6 to +6.7 letters) and RVO (+10.3 to +11.7 letters for BRVO, +5.9 to +17.7 letters for CRVO and 10.2 to 20.7 letters for HRVO). The median number of VEGF-inhibitor injections in eyes that completed 12-month follow-up also remained stable at 8-9 for nAMD, 6-7 for DMO, 7-9 for RVO. Fewer eyes (<one-fourth) that started treatment between 2015 and 2018 and more eyes starting in 2019 did not complete 12-month's follow-up visit. The mean VA in non-completers at their last visit was higher than that of their baseline visit. CONCLUSIONS: Treatment patterns and outcomes for nAMD, DMO and RVO in routine clinical practice have stabilised over the past 5 years at levels inferior to those reported by the pivotal phase 3 studies. A conscious effort to treat these conditions more intensively, or with longer lasting agents, would likely improve outcomes further in our patients.
目的:确定在常规临床实践中,新生血管性年龄相关性黄斑变性(nAMD)、糖尿病性黄斑水肿(DMO)和视网膜静脉阻塞(RVO)的治疗结果是否随时间而改变。
方法:我们分析了 2015 年和 2019 年开始接受阿柏西普或雷珠单抗治疗的治疗初治眼的 12 个月的结果,这些眼包括 nAMD(3802 只眼)、DMO(975 只眼)、分支 RVO(BRVO,357 只眼)、中央 RVO(CRVO,371 只眼)和半侧 RVO(HRVO,54 只眼),这些结果来自前瞻性设计的观察性 Fight Retinal Blindness!登记处。
结果:在 nAMD(+3.3 至+6 个字母)、DMO(+3.6 至+6.7 个字母)和 RVO(BRVO 为+10.3 至+11.7 个字母,CRVO 为+5.9 至+17.7 个字母,HRVO 为 10.2 至 20.7 个字母)中,2015 年至 2019 年期间每年的平均 VA 变化在 12 个月时保持稳定或随着时间的推移没有明显的趋势。在完成 12 个月随访的眼,接受 VEGF 抑制剂治疗的中位数也保持稳定,nAMD 为 8-9,DMO 为 6-7,RVO 为 7-9。2015 年至 2018 年开始治疗的眼较少(<四分之一)和 2019 年开始治疗的眼较多未完成 12 个月的随访。在最后一次就诊时,未完成者的平均 VA 高于基线就诊时的 VA。
结论:在过去的 5 年中,nAMD、DMO 和 RVO 的治疗模式和结果在常规临床实践中已经稳定,低于关键的 3 期研究报告的水平。如果更积极地治疗这些疾病,或使用更持久的药物,可能会进一步改善我们患者的治疗结果。
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