Department of Ophthalmology and Micro-technology, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan.
Department of Ophthalmology, Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan.
Sci Rep. 2023 Apr 7;13(1):5688. doi: 10.1038/s41598-023-32874-0.
The purpose of this study was to evaluate the 1-year visual outcomes of patients treated with intravitreal aflibercept (IVA) or brolucizumab (IVBr) for submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (AMD). We retrospectively studied 62 treatment-naïve eyes with SMHs exceeding one disc area (DA) secondary to AMD treated with IVA or IVBr. All patients received three monthly intravitreal injections in the loading phase followed by as-needed injections or fixed dosing. If a vitreous hemorrhage (VH) developed during the follow-up period, injections were discontinued and vitrectomy was performed. We evaluated the changes in the best-corrected visual acuity (BCVA) and factors that affected the BCVA improvement and VH development. A VH during treatment developed in five eyes (8.1%) (VH + group), and the mean BCVA worsened from 0.45 to 0.92. The BCVA improved significantly (P = 0.040) in the remaining 57 eyes (VH - group) from 0.42 to 0.36. The development of VHs was associated with significantly (P < 0.001) less VA improvement. Furthermore, large DAs and younger age at baseline were associated significantly (P = 0.010 and 0.046, respectively) with the development of VHs. Both IVA and IVBr appeared to improve functional outcomes in patients with SMH secondary to AMD when VHs did not develop. However, a VH developed in 8.1% of eyes after treatment. Although anti-vascular endothelial growth factor treatments were well-tolerated, for cases with large SMH at baseline, it should be considered that VH may occur during the monotherapy treatment process using IVA or IVBr, and that achieving good visual outcomes may be difficult in some cases.
本研究旨在评估玻璃体内注射阿柏西普（IVA）或康柏西普（IVBr）治疗新生血管性年龄相关性黄斑变性（AMD）继发的黄斑下出血（SMH）患者的 1 年视力结果。我们回顾性研究了 62 例未经治疗的 SMH 患者，这些患者的 SMH 超过 1 个视盘面积（DA），继发于 AMD。所有患者均在负荷期内接受 3 次每月的玻璃体内注射，随后按需注射或固定剂量注射。如果在随访期间发生玻璃体积血（VH），则停止注射并进行玻璃体切除术。我们评估了最佳矫正视力（BCVA）的变化以及影响 BCVA 改善和 VH 发展的因素。在治疗期间，5 只眼（8.1%）发生 VH（VH+组），BCVA 从 0.45 恶化至 0.92。在其余 57 只眼（VH-组）中，BCVA 从 0.42 显著改善至 0.36（P=0.040）。VH 的发生与 VA 改善明显相关（P<0.001）。此外，大的 DA 和较年轻的基线年龄与 VH 的发生明显相关（P=0.010 和 0.046）。当没有发生 VH 时，IVA 和 IVBr 似乎都能改善 AMD 继发 SMH 患者的功能结局。然而，在治疗后 8.1%的眼中发生了 VH。尽管抗血管内皮生长因子治疗具有良好的耐受性，但对于基线时存在大 SMH 的病例，应考虑到在使用 IVA 或 IVBr 的单药治疗过程中可能会发生 VH，并且在某些情况下可能难以获得良好的视力结果。
