Josifova Tatjana, Konieczka Katarzyna, Schötzau Andreas, Flammer Josef
Eye Clinic Orasis, Department for Medical and Surgical Retina, Reinach, Switzerland.
Department of Ophthalmology, University of Basel, Switzerland.
Adv Ophthalmol Pract Res. 2025 Mar 4;5(2):135-141. doi: 10.1016/j.aopr.2025.03.001. eCollection 2025 May-Jun.
Patients with nAMD often have pathologically elevated homocysteine (Hcy) and increased retinal venous pressure (RVP). We tested whether the administration of a specific vitamin preparation containing L-methylfolate (Ocufolin forte) as an addition to anti-VEGF therapy reduces these two risk factors and favorably influences the disease course.
A total of 27 eyes/27 patients with intra- and subretinal fluid, Hcy above 12 μmol/L, RVP of at least 8 mm above the IOP, and an IOP between 10 and 20 mmHg were included in this study. All eyes received three injections of 0.05 ml aflibercept at one-month intervals as clinically indicated. Fifteen patients additionally received one capsule of Ocufolin forte per day (Ocufolin group, OG), and the other twelve patients served as a control group (control group, CG). The following factors were measured before therapy and four months later: blood Hcy, best-corrected visual acuity (BCVA), intra-ocular pressure (IOP), RVP, optical coherence tomography (OCT), and optical coherence tomography - angiography (OCTA).
Hcy decreased on average by 5.58 μmol/L in the OG and by 0.57 μmol/L in the CG. The RVP decreased on average by 4.60 mmHg in the OG and by 0.75 mmHg in the CG. The difference between the two groups was significant for both parameters ( <0.001); 66% of the OG and 41% of the CG had no retinal fluid at the end of the study. After the completion of the study, the injection intervals could be extended more often in the OG patients than in the CG patients.
When Ocufolin forte was added to the standard therapy, RVP and Hcy were reduced to a significantly greater extent than without Ocufolin forte. In addition, Ocufolin had a positive influence on morphology and future treatment intervals with anti-VEGF therapy.
湿性年龄相关性黄斑变性（nAMD）患者通常存在病理性高同型半胱氨酸（Hcy）血症及视网膜静脉压（RVP）升高。我们测试了在抗血管内皮生长因子（VEGF）治疗基础上加用含L-甲基叶酸的特定维生素制剂（Ocufolin forte）是否能降低这两个危险因素并对疾病进程产生有利影响。
本研究共纳入27只眼/27例患者，这些患者存在视网膜内及视网膜下液，Hcy高于12 μmol/L，RVP至少比眼压高8 mmHg，眼压在10至20 mmHg之间。所有患眼均根据临床指征每隔1个月注射3次0.05 ml阿柏西普。15例患者额外每天服用1粒Ocufolin forte胶囊（Ocufolin组，OG），另外12例患者作为对照组（对照组，CG）。在治疗前及4个月后测量以下指标：血液Hcy、最佳矫正视力（BCVA）、眼压（IOP）、RVP、光学相干断层扫描（OCT）和光学相干断层扫描血管造影（OCTA）。
OG组Hcy平均下降5.58 μmol/L，CG组下降0.57 μmol/L。OG组RVP平均下降4.60 mmHg，CG组下降0.75 mmHg。两组间这两个参数的差异均具有显著性（<0.001）；研究结束时，OG组66%的患者和CG组41%的患者无视网膜下液。研究完成后，OG组患者比CG组患者更常能延长注射间隔时间。
在标准治疗基础上加用Ocufolin forte时，RVP和Hcy的降低幅度显著大于未加用Ocufolin forte时。此外，Ocufolin对形态学以及抗VEGF治疗的未来治疗间隔有积极影响。
