Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Acta Ophthalmol. 2023 Mar;101(2):177-184. doi: 10.1111/aos.15233. Epub 2022 Aug 29.
The administration frequency of intravitreal anti-vascular endothelial growth factor (anti-VEGF) in neovascular age-related macular degeneration (AMD) have been widely discussed. The primary objective of the study was to explore the association between anatomical outcomes and changes in functional outcome.
This was a retrospective cohort study of patients with newly diagnosed neovascular AMD with a minimum of 12 months of follow-up. Only one eye per patient was included. Patients were treated according to the observe-and-plan or the pro-re-nata regimen. All patients were regularly examined from the time of diagnosis up to 24 months. The effect of intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelium detachment (PED) at any time point on visual acuity (VA) was tested, as well as the long-term effect and the risk of losing VA. Further, the variability of central retinal thickness (CRT) was calculated for each eyes' individual measures during the observation period, excluding the monthly loading phase. The prognostic effect of each factor on VA was estimated by regression analysis. The primary outcome measure was VA, which was correlated with the presence or absence of fluid, seen as IRF, SRF or PED.
A total of 504 treatment naïve eyes from 504 patients was included. The presence of IRF was associated with lower VA at all visits (p < 0.001). However, the presence of SRF or PED was not significantly associated with worse VA at any time point during the observation period. Patients in the upper quartile of CRT variance had a greater loss in VA after 12 and 24 months (p < 0.001).
In this retrospective cohort study, the presence of intraretinal fluid was associated with poorer visual outcome in neovascular AMD patients treated with anti-VEGF, but the presence of subretinal fluid and PEDs was not. This suggests that IRF is worse than subretinal fluid and PEDs for AMD outcomes and therefore requires the most intensive treatment. Further, we found that patients with the highest CRT variability during the study period had poorer visual outcomes after 12 and 24 months, indicating that stringent control of retinal fluid volume fluctuations is important to prevent visual acuity decline over time.
抗血管内皮生长因子（anti-VEGF）在新生血管性年龄相关性黄斑变性（AMD）中的给药频率已广泛讨论。本研究的主要目的是探讨解剖学结果与功能结果变化之间的关系。
这是一项回顾性队列研究，纳入了至少有 12 个月随访的新诊断的新生血管性 AMD 患者。每位患者仅纳入一只眼。根据观察和计划或按需给药方案治疗所有患者。所有患者均在诊断时直至 24 个月定期进行检查。在任何时间点，测试视网膜内液（IRF）、视网膜下液（SRF）和色素上皮脱离（PED）对视敏度（VA）的影响，以及长期效果和丧失 VA 的风险。此外，在观察期间，为每只眼的个体测量值计算中央视网膜厚度（CRT）的变异性，不包括每月加载阶段。通过回归分析估计每个因素对视 VA 的预测效果。主要观察指标是 VA，它与是否存在液体（如 IRF、SRF 或 PED）相关。
共纳入 504 例 504 名患者的 504 只治疗初治眼。所有随访时均存在 IRF 的患者 VA 较低（p<0.001）。然而，在观察期间的任何时间点，存在 SRF 或 PED 的患者 VA 无显著降低。CRT 变异性较高的四分位患者在 12 个月和 24 个月后 VA 损失更大（p<0.001）。
在这项回顾性队列研究中，治疗新生血管性 AMD 患者时，存在视网膜内液与较差的视力结果相关，但存在视网膜下液和 PED 则无相关性。这表明，与视网膜下液和 PED 相比，IRF 对 AMD 结局更不利，因此需要最密集的治疗。此外，我们发现研究期间 CRT 变异性最高的患者在 12 个月和 24 个月后视力结果更差，这表明严格控制视网膜液体积波动对于防止随时间推移 VA 下降很重要。
