Funatsu Ryoh, Terasaki Hiroto, Mihara Naohisa, Sonoda Shozo, Shiihara Hideki, Sakamoto Taiji
Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Int J Retina Vitreous. 2024 Apr 8;10(1):32. doi: 10.1186/s40942-024-00553-5.
To compare the one-year outcomes between intravitreal brolucizumab (IVBr) monotherapy and photodynamic therapy (PDT) as a second-line treatment in patients with polypoidal choroidal vasculopathy (PCV) who did not respond to first-line therapy.
This case-control study included eyes with PCV that do not respond to aflibercept or ranibizumab. The patients were retrospectively registered. We compared outcomes, including best-corrected visual acuity (BCVA), anatomical results, and the need for additional treatments, between IVBr and a combination therapy using PDT as second-line treatments for refractory PCV, after adjusting for potential confounders. We analyzed E-values to evaluate the robustness of the results against unmeasured confounders.
Twenty-two eyes received IVBr, and twenty-four underwent PDT. No apparent differences were observed in BCVA and central macular thickness (CMT) changes from baseline between the groups (IVBr vs. PDT: BCVA, 0.01 ± 0.47 logMAR vs. 0.04 ± 0.18 logMAR, P-value = 0.756; CMT: - 36.3 ± 99.4 μm vs. - 114.7 ± 181.4 μm, P-value = 0.146). Only in the PDT group, five eyes (20.8%) did not require additional treatment after the second-line treatment, the adjusted odds ratio indicating no further treatment needed was 11.98 (95% confidence interval: 1.42-2070.07, P-value = 0.019). The E-value for the adjusted odds ratio was 23.44.
Both second-line treatments for PCV exhibited similar visual and anatomical outcomes. Only in the PDT-treated eyes were there some patients who did not require further treatment after second-line therapy.
比较玻璃体内注射布罗珠单抗（IVBr）单药治疗与光动力疗法（PDT）作为一线治疗无效的息肉状脉络膜血管病变（PCV）患者二线治疗的一年结局。
本病例对照研究纳入对阿柏西普或雷珠单抗无反应的PCV患眼。对患者进行回顾性登记。在调整潜在混杂因素后，我们比较了IVBr与使用PDT作为难治性PCV二线治疗的联合疗法之间的结局，包括最佳矫正视力（BCVA）、解剖学结果以及额外治疗的需求。我们分析了E值以评估结果对未测量混杂因素的稳健性。
22只眼接受了IVBr治疗，24只眼接受了PDT治疗。两组间BCVA和中心黄斑厚度（CMT）较基线的变化无明显差异（IVBr组与PDT组：BCVA，0.01±0.47 logMAR对0.04±0.18 logMAR，P值=0.756；CMT：-36.3±99.4μm对-114.7±181.4μm，P值=0.146）。仅在PDT组中，5只眼（20.8%）在二线治疗后无需额外治疗，调整后的无需进一步治疗的优势比为11.98（95%置信区间：1.42-2070.07，P值=0.019）。调整后优势比的E值为23.44。
PCV的两种二线治疗在视觉和解剖学结局方面相似。仅在接受PDT治疗的眼中，有一些患者在二线治疗后无需进一步治疗。
