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抗血管内皮生长因子治疗新生血管性年龄相关性黄斑变性8年随访

Berg, K., Roald, A.B., Navaratnam, J., Bragadóttir, R.

期刊名称:Acta Ophthalmologica

卷期:2017年第95卷第8期

摘要

摘要:目的:旨在探讨抗血管内皮生长因子(VEGF)治疗和扩展治疗方案治疗新生血管性年龄相关性黄斑变性(nAMD)的长期视力结果。方法:回顾性分析了一只眼启动了nAMD贝伐单抗治疗的155例病例。在最后的8年随访中,40例患者(26%)继续接受随访。计算最佳矫正视力(BCVA)与基线值的平均变化。结果:在治疗的第一年,平均BCVA较基线明显改善,相当于6.1个字母的-0.11 logMAR单位,近似于早期治疗糖尿病视网膜病变研究(近似ETDRS)(p = <0.001)。治疗4年后,整个治疗组平均BCVA仍然明显改善,治疗6年后仍保持最后8年随访的40例亚组患者的平均BCVA仍然明显改善。此后,BCVA逐渐下降,8年时平均变化0.05 logMAR单位,相当于基线以下2.1近似字母(p = 0.530)。第一年的平均注射次数为6.1±2.8次,第八年的平均注射次数为5.4±3.5次。 5年时,眼底自发荧光显示有一定程度的黄斑萎缩。在最后的8年随访中,光学相干断层扫描(OCT)显示87.5%的患者具有稳定的新生血管病变,无积液。结论:在日常临床中,nAMD患者的治疗和扩展模式治疗可以改善并稳定几年来的视力。经过8年的随访,视力下降(VA)可以通过黄斑萎缩来解释。

PURPOSE:To investigate long-term visual results of treatment with anti-vascular endothelial growth factor (VEGF) agents for neovascular age-related macular degeneration (nAMD) following a treat-and-extend regimen.METHODS:Retrospective review of 155 patients who initiated treatment with bevacizumab for nAMD in one eye. At the final 8-year visit, 40 patients (26%) remained for follow-up. Mean change in best-corrected visual acuity (BCVA) was calculated compared to baseline values.RESULTS:Mean BCVA improved significantly from baseline during the first year of treatment, with -0.11 logMAR units equivalent to 6.1 approximate Early Treatment Diabetic Retinopathy Study (approxETDRS) letters (p = <0.001). Mean BCVA was still significantly improved after 4 years of treatment for the entire group of patients and after 6 years of treatment for the subgroup of 40 patients who remained at the final 8-year visit. Thereafter, BCVA gradually declined and at 8 years, there was a mean change of 0.05 logMAR units equivalent to 2.1 approxETDRS letters below baseline (p = 0.530). Mean number of injections during the first year was 6.1 ± 2.8 and during year 8 was 5.4 ± 3.5. At 5 years, fundus autofluorescence showed some degree of macular atrophy in all eyes. At the final 8-year visit, 87.5% of the eyes had stable neovascular lesions with no fluid on optical coherence tomography (OCT).CONCLUSION:In an everyday clinical setting, treatment of nAMD patients with a treat-and-extend modality provided improvement and stability of vision for several years. After 8 years of follow-up, there was a decline in visual acuity (VA) that could be explained by macular atrophic development.


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