Tuzla Public Hospital, Department of Ophthalmology, Istanbul, Turkey.
Okan University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey.
Eur J Ophthalmol. 2024 Mar;34(2):510-523. doi: 10.1177/11206721231185909. Epub 2023 Jul 5.
The aim of this study is to compare the efficacy of intravitreal aflibercept (IVA), bevacizumab (IVB), ranibizumab (IVR), and dexamethasone implant (IVDI) in the treatment of serous retinal detachment (SRD) caused by Irvine-Gass syndrome (IGS).
Retrospective cohort, comparative study.
The medical records of 128 eyes with no previous history of intravitreal agents in 128 IGS patients with SRD that received IVA, IVB, IVR, and IVDI monotherapy were retrospectively reviewed. The patients were divided into 4 groups, according to treatment. Patients with recurrence and/or were unresponsive following a course of topical steroids and non-steroidal anti-inflammatory drugs (NSAIDs) were included in the study. Best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and SRD were compared between the 4 treatment groups at baseline, at follow-up months 1, 3, 6, and 12, and at the final follow-up visit.
Serous retinal detachment completely resolved in 74%, 45.7%, 66.4%, and 40.8% of the eyes at month 1 (P = 0.042), 87%, 50.9%, 75.8%, and 80.9% at month 3 (p = 0.031), 88.9%, 50.4%, 75.7%, 80.2% at month 6 (p = 0.028), 81.7%, 72.8%, 68.7%, 80.1% at month 12 (p = 0.580), and 100%, 66.4%, 87.9%, 93.2% (p = 0.478) at final follow-up visit in the IVA, IVB, IVR, and IVDI groups, respectively. BCVA was significantly better in the IVA group at all follow-up time points (month 1: p < 0.001; month 3: p < 0.001; month 6: p = 0.002; month 12: p = 0.009, final follow-up visit: p < 0.001). CMT was significantly lower in the IVA group at months 3 (p = 0.008), 6 (p = 0.011), and 12 (p = 0.010), and at the final follow-up visit (p < 0.001). Recurrence was observed after a longer period of time and fewer injections were needed in the IVDI and IVA groups (p < 0.05). Resolution of CME was most rapid in the IVA group (p = 0.032).
All intravitreal agents were effective in terms of visual results in the SRD patients; however, eyes treated with IVA and IVDI required fewer injections, as compared to the eyes treated with IVB and IVR. Furthermore, SRD entirely resolved in all eyes in the IVA group at the final follow-up visit.
本研究旨在比较玻璃体内注射阿柏西普（IVA）、贝伐珠单抗（IVB）、雷珠单抗（IVR）和地塞米松植入物（IVDI）治疗 Irvine-Gass 综合征（IGS）引起的浆液性视网膜脱离（SRD）的疗效。
回顾性队列，比较研究。
回顾性分析了 128 例 IGS 患者 128 只眼无玻璃体腔注药史的 SRD 患者的病历，这些患者接受了 IVA、IVB、IVR 和 IVDI 单药治疗。根据治疗方法将患者分为 4 组。纳入了在接受皮质类固醇和非甾体抗炎药（NSAIDs）局部治疗后复发和/或无反应的患者。在基线、随访 1、3、6 和 12 个月以及最终随访时比较 4 种治疗组的最佳矫正视力（BCVA）、中心视网膜厚度（CMT）、脉络膜下视网膜厚度（SFCT）和 SRD。
在第 1 个月时，74%、45.7%、66.4%和 40.8%的眼完全缓解 SRD（P = 0.042），第 3 个月时 87%、50.9%、75.8%和 80.9%（p = 0.031），第 6 个月时 88.9%、50.4%、75.7%和 80.2%（p = 0.028），第 12 个月时 81.7%、72.8%、68.7%和 80.1%（p = 0.580），第 12 个月时 100%、66.4%、87.9%和 93.2%（p = 0.478），IVA、IVB、IVR 和 IVDI 组分别完全缓解 SRD。IVA 组在所有随访时间点的 BCVA 均显著改善（第 1 个月：p < 0.001；第 3 个月：p < 0.001；第 6 个月：p = 0.002；第 12 个月：p = 0.009，最终随访：p < 0.001）。第 3 个月（p = 0.008）、第 6 个月（p = 0.011）、第 12 个月（p = 0.010）和最终随访时（p < 0.001）IVA 组的 CMT 显著降低。IVA 和 IVDI 组需要更长的时间和更少的注射次数来控制复发（p < 0.05）。IVA 组 CME 缓解最快（p = 0.032）。
所有玻璃体内注射药物在 SRD 患者的视力结果方面均有效；然而，与 IVB 和 IVR 治疗组相比，IVA 和 IVDI 治疗组需要更少的注射次数。此外，IVA 组所有患者在最终随访时均完全缓解 SRD。
