Discipline of Orthoptics, La Trobe University, Melbourne, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Semin Ophthalmol. 2023 Aug;38(6):592-597. doi: 10.1080/08820538.2023.2176239. Epub 2023 Feb 9.
Traditionally, visual acuity gain and central retinal thickness have been used to measure outcomes when investigating the efficacy of vascular endothelial growth factor (VEGF) inhibitors for patients with neovascular age-related macular degeneration (nARMD). However, localization of retinal fluid may offer additional prognostic value for treatment. The primary aim of this retrospective clinical audit was to investigate whether the presence and location of subretinal fluid has an effect on the visual outcomes of treatment naïve patients with nARMD treated in the real-world setting with VEGF inhibitors. Secondary aims included investigation of change to visual and anatomical outcomes and investigation of the dosing schedule.
Retrospective observational study of patients attending one suburban and one regional ophthalmology clinic requiring treatment with VEGF inhibitors for nARMD using single-user non-identifiable data from the Fight Retinal Blindness! Registry from 2014 to 2020. Visual acuity (VA) and central subfield thickness (CST) were recorded at baseline, 3, 6, 12 and 24 months.
Forty-nine eyes of 42 treatment naïve patients were included for analysis (aged 62-89 years). Almost half (49%) presented with a combination of intra- and subretinal fluid at baseline. Intraretinal fluid was present in 75% of eyes but decreased to 22.7% of eyes by 24 months. VA at baseline was 55 letters, and this improved by 6 letters. The change in VA from baseline to 3, 6 and 12 months was statistically significant (p < .05). The mean change in CST from baseline to 3 months was significant (-76 µm). This change was also observed at the other milestones (p < .001).
The findings of this study suggest that allowing some subretinal fluid to remain will not affect treatment outcomes.
传统上，评估血管内皮生长因子 (VEGF) 抑制剂治疗新生血管性年龄相关性黄斑变性 (nARMD) 患者的疗效时，使用视力提高和中心视网膜厚度来衡量结果。然而，视网膜下液的定位可能为治疗提供额外的预后价值。本回顾性临床审计的主要目的是研究在真实环境中使用 VEGF 抑制剂治疗的初治 nARMD 患者中，视网膜下液的存在和位置是否会影响治疗效果。次要目的包括研究视力和解剖学结果的变化，以及研究给药方案。
对 2014 年至 2020 年期间，在一个郊区和一个地区眼科诊所就诊的需要接受 VEGF 抑制剂治疗 nARMD 的患者进行回顾性观察性研究，使用 Fight Retinal Blindness！注册中心的单一用户不可识别数据。在基线、3、6、12 和 24 个月时记录视力 (VA) 和中心子场厚度 (CST)。
纳入 42 例初治患者的 49 只眼进行分析（年龄 62-89 岁）。近一半（49%）患者在基线时存在视网膜内和视网膜下液的混合。75%的眼存在视网膜内液，但到 24 个月时减少到 22.7%。基线时的 VA 为 55 个字母，提高了 6 个字母。从基线到 3、6 和 12 个月的 VA 变化具有统计学意义（p<.05）。从基线到 3 个月 CST 的平均变化具有显著意义（-76µm）。在其他里程碑也观察到这种变化（p<.001）。
本研究的结果表明，允许一些视网膜下液残留不会影响治疗效果。
