用法西单抗靶向 Tie-2 受体治疗中心性浆液性脉络膜视网膜病变：基于一项基因发现的病例系列研究
Targeting the Tie-2 Receptor With Faricimab in Central Serous Chorioretinopathy: A Case Series Motivated by a Genetic Finding.
作者信息
Rämö Joel T, Kim Leo A, Stryjewski Tomasz, Shah Priya P, Bejjani Romy, Brodie Frank L, Eliott Dean, Sobrin Lucia, Vavvas Demetrios G, Rossin Elizabeth J
机构信息
From the Broad Institute of MIT and Harvard (J.T.R., E.J.R.), Cambridge, Massachusetts, USA; Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE) (J.T.R.), University of Helsinki, Helsinki, Finland; Massachusetts Eye and Ear (J.T.R., D.E., L.S., D.G.V., E.J.R.), Boston, Massachusetts, USA.
Department of Ophthalmology (L.A.K., P.P.S., R.B., D.E., L.S., D.G.V., E.J.R.), Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
出版信息
Am J Ophthalmol. 2025 Jan;269:246-254. doi: 10.1016/j.ajo.2024.08.040. Epub 2024 Sep 2.
PURPOSE
To investigate the effects of faricimab, a bispecific antibody targeting VEGF and Ang-2 (thus increasing Tie-2 activity), in patients with CSC based on a recent genetic study that implicated Tie-2 signaling in CSC pathophysiology.
DESIGN
A retrospective interventional multicenter case series.
METHODS
We included patients with chronic CSC (persistent or recurrent SRF for ≥6 months) who received at least one faricimab 6 mg injection between January 1 2022, and April 1 2024,. Study sites included Massachusetts Eye and Ear and University of California San Francisco. Patients with evidence of a choroidal neovascular membrane on color photos, optical coherence tomography (OCT) and/or fluorescein angiography were excluded. 16 eyes (15 patients) met the inclusion criteria. The median central macular thickness at each visit from 52 weeks before to 52 weeks after the first faricimab injection was calculated using automated Heidelberg Spectralis ETDRS subfield measurements.
RESULTS
Prior to treatment with faricimab, CSC had been diagnosed a median of 4.1 years (range 0.9-8) earlier and SRF (and intraretinal fluid [IRF] in a subset) had been continuously present for a median of 30 weeks (range 9-257). Decreases in macular thickness were observed in 14/16 eyes after the first faricimab injection and in 14/16 eyes in the full follow-up period compared with prior, 10 of which experienced complete resolution of SRF following the start of the first series of injections at a median of 4 weeks (range 2-25). One eye worsened after the second injection. The median improvement in macular thickness was 40 μm [range -3 to 89.5] (P = .0007). Upon review of OCT images, reductions in macular thickness were consistent with reductions in SRF and/or IRF. Visual acuity improved by 2 lines or more in 6/16 eyes.
CONCLUSIONS
In a retrospective case series of patients with chronic CSC and longstanding SRF, we observed improvement in macular thickness after intravitreal faricimab. While the small number of patients and variable natural history of CSC preclude definitive conclusions, a randomized controlled trial seems warranted.
目的
基于一项近期的基因研究，该研究表明Tie-2信号传导参与了中心性浆液性脉络膜视网膜病变（CSC）的病理生理过程，本研究旨在探讨faricimab（一种靶向血管内皮生长因子（VEGF）和血管生成素-2的双特异性抗体，从而增加Tie-2活性）对CSC患者的影响。
设计
一项回顾性干预性多中心病例系列研究。
方法
我们纳入了慢性CSC（持续性或复发性视网膜下液（SRF）≥6个月）患者，这些患者在2022年1月1日至2024年4月1日期间接受了至少一次6mg的faricimab注射。研究地点包括马萨诸塞州眼耳医院和加利福尼亚大学旧金山分校。排除在彩色照片、光学相干断层扫描（OCT）和/或荧光素血管造影检查中有脉络膜新生血管膜证据的患者。16只眼（15例患者）符合纳入标准。使用自动海德堡Spectralis ETDRS子区域测量法计算首次faricimab注射前52周至注射后52周每次随访时的中央黄斑厚度中位数。
结果
在使用faricimab治疗前，CSC的诊断时间中位数为4.1年（范围0.9 - 8年），SRF（以及部分患者的视网膜内液[IRF]）持续存在的时间中位数为30周（范围9 - 257周）。首次faricimab注射后，14/16只眼中观察到黄斑厚度降低，与之前相比，在整个随访期内14/16只眼中均有降低，其中10只眼在首次系列注射开始后中位数4周（范围2 - 25周）时SRF完全消退。一只眼在第二次注射后病情恶化。黄斑厚度的中位数改善为40μm [范围 -3至89.5]（P = 0.0007）。通过回顾OCT图像，黄斑厚度的降低与SRF和/或IRF的减少一致。16只眼中有6只眼的视力提高了2行或更多。
结论
在一个慢性CSC和长期SRF患者的回顾性病例系列中，我们观察到玻璃体内注射faricimab后黄斑厚度有所改善。虽然患者数量较少且CSC的自然病程多变，无法得出确定性结论，但似乎有必要进行一项随机对照试验。
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