Kawakami Setsuko, Wakabayashi Yoshihiro, Watanabe Yoko, Umazume Kazuhiko, Yamamoto Kaori, Goto Hiroshi
Department of Ophthalmology Tokyo Medical University, Tokyo 160-0023, Japan.
J Ophthalmol. 2024 Jul 5;2024:8336516. doi: 10.1155/2024/8336516. eCollection 2024.
To investigate the dropout rate of anti-vascular endothelial growth factor (VEGF) treatment for macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and identify the characteristics of dropout cases.
We studied 235 eyes of 235 treatment-naïve BRVO-ME patients receiving intravitreal injection of ranibizumab. Additional intravitreal anti-VEGF drug was given when ME relapsed or persisted, and photocoagulation was performed as needed. Adherence until treatment completion was defined as disappearance of ME within 2 years after the first injection without recurrence for more than 6 months or mild ME remaining but no visual deterioration for more than 6 months without additional anti-VEGF drug. In patients with ME recurrence, those who were followed for more than 2 years were considered adherence, and those followed for less than 2 years were considered dropout. The clinical course and background of the two groups were compared.
179 patients (76.2%) adhered to treatment and 56 patients (23.8%) dropped out. Mean follow-up periods in adherence and dropout groups were 23.4 and 7.1 months, respectively. There were no significant differences between the two groups in demographic and baseline factors of age, gender ratio, distance from home to hospital, visual acuity, and foveal thickness (FT). At the last follow-up, visual acuity was significantly poorer in the dropout group than in the adherence group (0.23 vs. 0.11 logMAR, =0.003), and FT was significantly greater in the dropout group than in the adherence group (316 vs. 273 m, =0.002). Reasons for dropout included patient declining further treatment in 12.5%, progression of dementia in 8.9%, others, and unknown in 64.3%.
The clinical outcome of patients who dropped out of anti-VEGF therapy for BRVO-ME was worse compared to patients who adhered to therapy, and the reasons for discontinuation varied.
研究抗血管内皮生长因子（VEGF）治疗视网膜分支静脉阻塞（BRVO）继发黄斑水肿（ME）的停药率，并确定停药病例的特征。
我们研究了235例初治的BRVO-ME患者的235只眼，这些患者接受了玻璃体内注射雷珠单抗治疗。当ME复发或持续存在时给予额外的玻璃体内抗VEGF药物，并根据需要进行光凝治疗。直至治疗完成的依从性定义为首次注射后2年内ME消失且无复发超过6个月，或仍有轻度ME但在无额外抗VEGF药物的情况下超过6个月视力无恶化。在ME复发的患者中，随访超过2年的患者被视为依从性患者，随访不足2年的患者被视为停药患者。比较两组的临床病程和背景。
179例患者（76.2%）坚持治疗，56例患者（23.8%）停药。依从性组和停药组的平均随访时间分别为23.4个月和7.1个月。两组在年龄、性别比例、家到医院的距离、视力和黄斑中心凹厚度（FT）等人口统计学和基线因素方面无显著差异。在最后一次随访时，停药组的视力明显低于依从性组（logMAR分别为0.23和0.11，P=0.003），停药组的FT明显高于依从性组（分别为316μm和273μm，P=0.002）。停药原因包括12.5%的患者拒绝进一步治疗、8.9%的患者痴呆进展、其他原因以及64.3%的原因不明。
与坚持治疗的患者相比，BRVO-ME抗VEGF治疗停药患者的临床结局更差，停药原因各不相同。
