Puzo Martín, Calvo-Perez Pilar, Bartol-Puyal Francisco, Sanchez-Monroy Jorge, Martin-Pinardel Ruben, Parrado-Carrillo Alba, Moll-Udina Aina, Bernal-Morales Carolina, Sanchez-Vela Laura, Sararols-Ramsay Laura, Garay-Aramburu Gonzaga, Arruabarrena Carolina, García-Arumí José, Abraldes Maximino, Ruiz-Moreno José María, Valldeperas Xavier, Velázquez-Villoria Daniel, Escobar-Barranco José Juan, Gallego-Pinazo Roberto, Figueroa Marta S, Figueras-Roca Marc, Barthelmes Daniel, Gillies Mark C, Casaroli-Marano Ricardo P, Zarranz-Ventura Javier
Miguel Servet Ophthalmology Research Group (GIMSO), Miguel Servet University Hospital, Aragón Institute for Health Research (IIS-Aragón), Universidad de Zaragoza, Zaragoza, Spain.
Fundació de Recerca Clínic Barcelona-Institut de Investigacions Biomediques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain.
Eye (Lond). 2024 Dec;38(18):3450-3458. doi: 10.1038/s41433-024-03322-8. Epub 2024 Sep 21.
To compare visual outcomes for low vision eyes (LVE) (<35 letters LogMAR or <20/200 Snellen) versus non-low vision eyes (NLVE) (>35 letters LogMAR or >20/200 Snellen) at the time of the first injection in a clinical practice setting.
Subgroup analysis of a multicenter national database of treatment- naïve eyes neovascular age related macular degeneration (nAMD) treated with anti-VEGF intravitreal injections divided into LVE and NLVE. Demographics, visual acuity (VA) at baseline and subsequent timepoints (12, 24, and 36 months), number of injections and visits data were collected using a validated web-based tool (Fight Retinal Blindness!).
3138 eyes were included, 705 LVE and 2433 NLVE. The LVE group had the greatest VA gain (p < 0.001), at 12, 24, and 36 months (+15, +15, and +13 letters respectively). The proportion of patients with VA loss (-5 letters) differed between groups at 12, 24, and 36 and was significantly greater (p < 0.001) in NLVE. The proportion of patients with VA gain (+5 letters) was significantly higher (p < 0.001) in LVE in all timeframes. The proportions of LVE that still had VA ≤ 35 letters at 12, 24, and 36 months were 54%, 54%, and 57%. Conversely, 8%, 9%, and 8% of LVE achieved VA ≥ 70 letters at 12, 24, and 36 months. LVE received fewer intravitreal injections than NLVE throughout follow-up (6, 9, 12 vs 7, 11, 15).
Findings of this study support the need for ongoing therapy in patients with initial visual acuity less than 35 letters since sustained visual improvements can be achieved and maintained for the first 3 years of treatment.
在临床实践环境中，比较首次注射时低视力眼（LVE）（LogMAR视力表字母数<35或Snellen视力表<20/200）与非低视力眼（NLVE）（LogMAR视力表字母数>35或Snellen视力表>20/200）的视觉效果。
对一个多中心全国性数据库进行亚组分析，该数据库包含未经治疗的新生血管性年龄相关性黄斑变性（nAMD）眼，这些眼接受了抗VEGF玻璃体内注射治疗，并分为LVE和NLVE组。使用经过验证的基于网络的工具（抗击视网膜失明！）收集人口统计学数据、基线及后续时间点（12、24和36个月）的视力（VA）、注射次数和就诊数据。
共纳入3138只眼，其中705只为LVE，2433只为NLVE。LVE组在12、24和36个月时视力提高最多（p<0.001）（分别提高15、15和13个字母）。12、24和36个月时，视力下降（-5个字母）的患者比例在两组间存在差异，NLVE组显著更高（p<0.001）。在所有时间范围内，LVE组视力提高（+5个字母）的患者比例显著更高（p<0.001）。12、24和36个月时，仍有VA≤35个字母的LVE比例分别为54%、54%和57%。相反，12、24和36个月时，分别有8%、9%和8%的LVE达到VA≥70个字母。在整个随访期间，LVE接受的玻璃体内注射次数少于NLVE（分别为6、9、12次与7、11、15次）。
本研究结果支持对初始视力低于35个字母的患者进行持续治疗的必要性，因为在治疗的前3年可以实现并维持视力的持续改善。
