Kim Minhee, Kang Ji Eon, Park Young Gun
Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
J Clin Med. 2024 Jun 12;13(12):3434. doi: 10.3390/jcm13123434.
: This study aimed to assess the effectiveness of bi-monthly brolucimumab treatment in patients with neovascular age-related macular degeneration (nAMD) refractory to monthly aflibercept treatment. : A retrospective chart review included 32 eyes of patients with refractory nAMD who switched from monthly intravitreal aflibercept treatment to bi-monthly intravitreal brolucizumab treatment. This study evaluated changes in visual acuity (VA), intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), and central macular thickness (CMT), at specific times as follows: baseline before switching (T0), 2 months after switching (T1), 4 months after switching (T2), and 6 months after switching (T3). : The mean best-corrected visual acuity (BCVA) did not significantly change across all time points (0.52 ± 0.12, 0.48 ± 0.27, 0.48 ± 0.28, and 0.50 ± 0.27 logarithms of the minimum angle of resolution in T0, T1, T2, and T3, respectively). CMT significantly decreased after additional brolucizumab injections compared to the baseline (218.2 ± 48.6 and 207.9 ± 49.8 μm, respectively; = 0.001). The PED height also significantly decreased from 251.0 ± 165.4 to 154.4 ± 115.65 μm ( < 0.001), with complete resolution in nine patients (28%). The mean subfoveal choroidal thickness (SFCT) before brolucizumab treatment was 262.8 ± 79.7 μm, which decreased to 233.0 ± 71.2 μm ( = 0.001) after the first injection. The final SFCT also significantly decreased after additional brolucizumab injections compared to the baseline SFCT ( = 0.012). : Bi-monthly brolucizumab treatment proves effective for patients refractory to monthly fixed aflibercept, resulting in positive anatomical changes without significant deterioration in visual acuity. This approach provides a promising prognosis while reducing the treatment burden on refractory patients.
本研究旨在评估每两个月一次注射布罗利尤单抗治疗对每月一次注射阿柏西普治疗无效的新生血管性年龄相关性黄斑变性（nAMD）患者的有效性。一项回顾性病历审查纳入了32只难治性nAMD患者的眼睛，这些患者从每月一次玻璃体内注射阿柏西普治疗改为每两个月一次玻璃体内注射布罗利尤单抗治疗。本研究评估了特定时间点的视力（VA）、视网膜内液（IRF）、视网膜下液（SRF）、色素上皮脱离（PED）和中心黄斑厚度（CMT）的变化，具体如下：转换前的基线（T0）、转换后2个月（T1）、转换后4个月（T2）和转换后6个月（T3）。在所有时间点，平均最佳矫正视力（BCVA）没有显著变化（T0、T1、T2和T3时分别为0.52±0.12、0.48±0.27、0.48±0.28和0.50±0.27最小分辨角对数）。与基线相比，额外注射布罗利尤单抗后CMT显著降低（分别为218.2±48.6和207.9±49.8μm；P = 0.001）。PED高度也从251.0±165.4μm显著降低至154.4±115.65μm（P < 0.001），9例患者（28%）完全消退。布罗利尤单抗治疗前平均黄斑中心凹下脉络膜厚度（SFCT）为262.8±79.7μm，首次注射后降至233.0±71.2μm（P = 0.001）。与基线SFCT相比，额外注射布罗利尤单抗后最终SFCT也显著降低（P = 0.012）。每两个月一次注射布罗利尤单抗治疗对每月一次固定注射阿柏西普无效的患者有效，可导致积极的解剖学变化，且视力无显著恶化。这种方法在减轻难治性患者治疗负担的同时，提供了良好的预后。
