Abu Dail Yaser, Seitz Berthold, Sideroudi Haris, Abdin Alaa D
Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.
Acta Ophthalmol. 2023 May;101(3):330-341. doi: 10.1111/aos.15283. Epub 2022 Nov 8.
To compare the effects of monotherapy with intravitreal ranibizumab, aflibercept and bevacizumab on retinal ganglion cell layer (RGCL) and retinal nerve fibre layer (RNFL) in patients with naïve neovascular age-related macular degeneration (nAMD).
This is a retrospective cohort study with three-groups comparison. 83 patients and 97 eyes on continuous monotherapy with an intravitreal anti-vascular endothelial growth factor (anti-VEGF) were followed for 24 months and divided into three groups according to anti-VEGF (aflibercept: 25 eyes, ranibizumab: 34 eyes, bevacizumab: 38 eyes). Main outcome measures included: RGCL and RNFL thickness, best corrected visual acuity (BCVA), central macular thickness (CMT), macular volume (MV) and the presence of intraretinal fluids (IRF), subretinal fluids (SRF) and retinal pigment epithelial atrophy (RPE-atrophy). All outcome measures were recorded at the time of the first injection, 1 and 2 years after treatment and compared longitudinally and between groups.
The mean age was 79 ± 7 years. The RGCL thickness, MV, CMT and the presence of IRF and SRF decreased significantly within all three medication groups (p < 0.05 for all) with no significant difference between groups over the 2-year follow-up period (p > 0.10 for all). The decrease in RNFL thickness was not significant within or between the groups after a 2-year follow-up (p > 0.055 for all). RPE-atrophy increased significantly after 2 years in all three groups (p < 0.028 for all) with no significant difference between groups at all three time points (p > 0.307 for all). BCVA was comparable between the three groups over the 2-year follow-up period (p > 0.22 for all).
Monotherapy with intravitreal aflibercept, bevacizumab and ranibizumab was associated with comparable significant decreases in RGCL thickness, CMT, MV, IRF and SRF in naïve nAMD patients during the first 2 years of treatment. Furthermore, no significant differences either in BCVA or RNFL thickness were observed between the three intravitreal anti-VEFGs during the first 2 years of treatment.
比较玻璃体内注射雷珠单抗、阿柏西普和贝伐单抗单药治疗对初发新生血管性年龄相关性黄斑变性（nAMD）患者视网膜神经节细胞层（RGCL）和视网膜神经纤维层（RNFL）的影响。
这是一项三组比较的回顾性队列研究。83例患者共97只眼持续接受玻璃体内抗血管内皮生长因子（anti-VEGF）单药治疗，随访24个月，并根据抗VEGF药物分为三组（阿柏西普：25只眼，雷珠单抗：34只眼，贝伐单抗：38只眼）。主要观察指标包括：RGCL和RNFL厚度、最佳矫正视力（BCVA）、中心黄斑厚度（CMT）、黄斑体积（MV）以及视网膜内液（IRF）、视网膜下液（SRF）和视网膜色素上皮萎缩（RPE萎缩）的存在情况。所有观察指标均在首次注射时、治疗后1年和2年记录，并进行纵向和组间比较。
平均年龄为79±7岁。所有三个用药组的RGCL厚度、MV、CMT以及IRF和SRF的存在情况均显著下降（均p<0.05），在2年随访期内组间无显著差异（均p>0.10）。2年随访后，组内和组间RNFL厚度的下降均不显著（均p>0.055）。所有三组在2年后RPE萎缩均显著增加（均p<0.028），在所有三个时间点组间均无显著差异（均p>0.307）。在2年随访期内，三组的BCVA相当（均p>0.22）。
在初发nAMD患者治疗的前2年，玻璃体内注射阿柏西普、贝伐单抗和雷珠单抗单药治疗均使RGCL厚度、CMT、MV、IRF和SRF显著下降且效果相当。此外，在治疗的前2年，三种玻璃体内抗VEGF药物在BCVA或RNFL厚度方面均未观察到显著差异。
