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玻璃体腔内注射治疗年龄相关性黄斑变性后感染性和非感染性眼内炎的发生率和预后

Daien, V., Nguyen, V., Essex, R.W., Morlet, N., Barthelmes, D., Gillies, M.C.

期刊名称:Ophthalmology

卷期:2018年第125卷第1期

摘要

摘要:目的:旨在评估抗血管内皮生长因子(VEGF)药物玻璃体腔内注射(IVTs)后感染性和非感染性眼内炎的发生率,累积率和长期预后。设计:前瞻性设计的数据库研究。研究对象:200611日至20161130日期间开始抗VEGF治疗的抗击视网膜失明(FRB!)注册研究追踪的新生血管性年龄相关性黄斑变性(nAMD)初治眼。方法:使用Cox-比例风险模型测量累积的眼内炎率和生存曲线。使用局部加权散点图平滑曲线显示视力(VA)。主要观察指标:眼内炎发生率和累积发生率以及眼内炎后12个月的VA变化。结果:88150次注射中有18次发生感染性眼内炎(1/4897注射[0.020]; 95%可信区间[CI]0.012-0.032),抗VEGF药物类型之间没有差异(P = 0.896)。 10,20,30,40,5060IVT后,感染性眼内炎累计发生率分别为0.055%,0.183%,0.360%,0.360%,0.555%和0.843%。然而,感染性眼内炎的“风险”并没有随着每次注射而增加(P = 0.202)。88 150次注射中发生11次非感染性眼内炎(1/8013次注射[0.012]; 95CI0.006-0.022)。在10次和20IVTs后非感染性眼内炎的累积发生率分别为0.087%和0.228%,然后在60IVTs中保持稳定。与雷珠单抗(3/54 7760.005; P = 0.005)和阿柏西普(0/23 425; P = 0.016)相比,贝伐单抗非感染性眼内炎的发生率更高(8/99310.081%),雷珠单抗和阿柏西普之间未见差异(P = 1.0)。53%和75%的感染性和非感染性眼内炎的12个月VA分别在±2线内; 31%25%的眼的视力下降>2线。结果:IVT后感染性和非感染性眼内炎发生率较低,每次注射后风险均不增加。与雷珠单抗或阿柏西普相比,我们发现贝伐单抗非感染性眼内炎的发生率更高。四分之三的感染性病例和三分之二的非感染性眼内炎病例在眼内炎前视力保持在10个字母内。

PURPOSE:To assess the incidence, cumulative rate, and long-term outcomes of infectious and noninfectious endophthalmitis after intravitreal injections (IVTs) of anti-vascular endothelial growth factor (VEGF) agents.DESIGN:Database study, prospectively designed.PARTICIPANTS:Treatment-na ve eyes with neovascular age-related macular degeneration (nAMD) tracked by the Fight Retinal Blindness! (FRB!) registry that commenced anti-VEGF therapy between January 1, 2006, and November 30, 2016.METHODS:Cumulative rate of endophthalmitis and survival curves were measured using Cox-proportional hazards models. Locally weighted scatterplot smoothing curves were used to display visual acuity (VA).MAIN OUTCOME MEASURES:Incidence and cumulative rate of endophthalmitis, and change in VA 12 months after endophthalmitis.RESULTS:Infectious endophthalmitis developed in 18 of 88 150 injections (1/4897 injections [0.020%]; 95% confidence interval [CI], 0.012-0.032) with no difference found between types of anti-VEGF medications (P = 0.896). The cumulative rate of infectious endophthalmitis per patient was 0.055%, 0.183%, 0.360%, 0.360%, 0.555%, and 0.843% after 10, 20, 30, 40, 50, and 60 IVTs, respectively. However, the "risk" of infectious endophthalmitis did not increase with each successive injection (P = 0.202). Noninfectious endophthalmitis developed in 11 of 88 150 injections (1/8013 injections [0.012%]; 95% CI, 0.006-0.022). The cumulative rate of noninfectious endophthalmitis per patient was 0.087% and 0.228% after 10 and 20 IVTs, respectively, and then remained stable up to 60 IVTs. The incidence of noninfectious endophthalmitis was higher for bevacizumab (8/9931, 0.081%) compared with ranibizumab (3/54 776, 0.005%; P = 0.005) and aflibercept (0/23 425; P = 0.016), and no differences were observed between ranibizumab and aflibercept (P = 1.0). The 12-month VA in infectious and noninfectious endophthalmitis was within ±2 lines of before endophthalmitis in 53% and 75% of eyes, respectively; a loss >2 lines was observed in 31% and 25% of eyes, respectively.CONCLUSIONS:The incidences of infectious and noninfectious endophthalmitis after IVT were low, and the risk did not increase with each successive injection. We found higher rates of noninfectious endophthalmitis with bevacizumab compared with ranibizumab or aflibercept. Three quarters of cases with infectious and two thirds of cases with noninfectious endophthalmitis retained vision within 10 letters of the pre-endophthalmitis level.


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