School of Medicine, Tel Aviv University, (A.A., O.T., U.E., I.H.) Tel Aviv, Israel; Department of Ophthalmology, Tel Aviv Medical Center, (A.A., O.T.) Tel Aviv, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, (B.K., R.T.) Beer-Sheva, Israel; Department of Ophthalmology, Soroka University Medical Center, (B.K.) Beer-Sheva, Israel.
Am J Ophthalmol. 2024 Oct;266:135-143. doi: 10.1016/j.ajo.2024.04.018. Epub 2024 Apr 29.
To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the development and progression of macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD).
Retrospective, clinical cohort study.
The study included patients with nAMD with anti-vascular endothelial growth factor (VEGF) injections who underwent uneventful cataract surgery between 2007 and 2018 with follow-up until June 2023. Subsequent MA rates were compared between subjects who received a BLF IOL or a non-BLF IOL. All optical coherence tomography scans were manually reviewed in a masked manner regarding patient baseline variables and IOL status by an experienced research technician. By using Heidelberg software, the area of MA was manually evaluated and calculated (mm) by the program. The overall risk of developing new-onset MA and the effect of IOL type on disease progression were assessed. Death was included as a censoring event.
Included were 373 eyes of 373 patients (mean age, 78.6 ± 6.7 years at surgery; 67.4% were female). BLF IOLs were implanted in 206 eyes, and non-BLF IOLs were implanted in 167 eyes with comparable follow-up times (3164 ± 1420 days vs 3180 ± 1403 days, respectively, P = .908) and other baseline parameters (age, gender, corrected distance visual acuity, macular thickness, cumulative number of anti-VEGF injections). Nine preexisting and 77 new-onset MA cases were detected, with similar distribution between BLF and non-BLF eyes (P = .598 and P = .399, respectively). Both univariate Kaplan-Meier (P = .366) and multivariate Cox regression analyses adjusted for age and gender showed that BLF-IOLs were comparable to non-BLF IOLs regarding hazard for new-onset MA (hazard ratio [HR], 1.236; 95% CI, 0.784-1.949; P = .363). Final MA area at the last visit was 5.14 ± 4.71 mm for BLF IOLs and 8.56 ± 9.17 mm for non-BLF IOLs (P = .028), with the mean annual MA area increase of 0.78 ± 0.84 mm and 1.26 ± 1.32 mm, respectively (P = .042).
BLF IOLs did not show added benefit over non-BLF IOLs in terms of MA-free survival but were associated with less progression over time in a cohort of patients with nAMD.
评估蓝光过滤（BLF）人工晶状体（IOL）对伴有新生血管性年龄相关性黄斑变性（nAMD）的眼睛中黄斑萎缩（MA）发展和进展的影响。
回顾性临床队列研究。
该研究纳入了接受抗血管内皮生长因子（VEGF）注射治疗 nAMD 且在 2007 年至 2018 年间无并发症白内障手术的患者，并随访至 2023 年 6 月。比较了接受 BLF IOL 或非 BLF IOL 的患者的后续 MA 发生率。所有光学相干断层扫描（OCT）扫描均由一位经验丰富的研究技术员以盲法方式根据患者的基线变量和 IOL 状态进行手动复查。使用海德堡软件，通过程序手动评估和计算（mm）MA 面积。评估了新发 MA 的总体风险以及 IOL 类型对疾病进展的影响。将死亡作为删失事件。
共纳入 373 名患者的 373 只眼（手术时平均年龄为 78.6±6.7 岁；67.4%为女性）。206 只眼植入了 BLF IOL，167 只眼植入了非 BLF IOL，随访时间相当（分别为 3164±1420 天和 3180±1403 天，P=0.908），其他基线参数（年龄、性别、矫正远视力、黄斑厚度、抗 VEGF 注射次数）也相似。共检出 9 例既往存在的 MA 和 77 例新发 MA，BLF 眼和非 BLF 眼的分布相似（P=0.598 和 P=0.399）。单变量 Kaplan-Meier（P=0.366）和多变量 Cox 回归分析均调整了年龄和性别因素，结果显示 BLF-IOL 在新发 MA 的危险方面与非 BLF IOL 相当（风险比 [HR]，1.236；95%CI，0.784-1.949；P=0.363）。BLF IOL 组最后一次就诊时的 MA 终末面积为 5.14±4.71mm，非 BLF IOL 组为 8.56±9.17mm（P=0.028），MA 年均面积增加分别为 0.78±0.84mm 和 1.26±1.32mm（P=0.042）。
在伴有 nAMD 的患者队列中，BLF IOL 在 MA 无进展生存率方面并未优于非 BLF IOL，但与时间推移下的 MA 进展较慢相关。
