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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后早,晚期视网膜色素上皮细胞撕裂

Invernizzi, A., Nguyen, V., Arnold, J., Young, S., Barthelmes, D., Gillies, M.C.

期刊名称:Ophthalmology

卷期:2018年第125卷第2期

摘要

摘要:目的:探讨在抗血管内皮生长因子(VEGF)治疗过程中,视网膜色素上皮(RPE)细胞撕裂的发生及其相关治疗模式及长期视力结果。

设计:前瞻性设计的观察数据库的病例对照分析。

参与者:参与治疗的治疗者的眼睛已进入了与视网膜的失明战斗的阶段!20061月至20171月间开始进行的抗血管内皮生长因子治疗年龄相关的新生血管黄斑变性的观察性研究已被确定。病例来自于在治疗过程中产生的视网膜色素上皮细胞撕裂的眼睛。每个病例的三个对照眼按照年龄、基线视力(VA)、病变大小、视网膜色素上皮细胞撕裂前治疗的持续时间以及随访时间进行了筛选。

方法:采用分段回归模型,对病例进行早期撕裂或晚期撕裂的分类。将两组的基线特征进行了比较。分别在基线、视网膜色素上皮细胞撕裂之前和术后立即进行视网膜色素上皮细胞撕裂眼和对照眼之间的基线视力和注射次数的比较,然后在1224个月后进行同样的比较工作。并比较各组不同就诊次数的视敏度。

主要观察指标:视敏度、视网膜色素上皮细胞撕裂时间、注射次数。

结果:包括55例视网膜色素上皮细胞撕裂眼和165例对照眼。依照分段回归结果估计在182天这个时间点有一个断点。因此,我们将在断点之前撕裂的定义为早期视网膜色素上皮细胞撕裂眼(55例中有38[占比为69%]),在断点之后撕裂的定义为晚期视网膜色素上皮细胞撕裂眼(55例中有17例,占比[31%])。与晚期相比,早期的基线视力显著降低(53.663.4letters;P = 0.009)。视力在撕裂前的视网膜色素上皮细胞撕裂前早期已有所改善。(基线以上+5.6lettersP = 0.01),在撕裂后立即下降(-8.3letters;P = 0.002),然后在12个月和24个月后恢复的情况并无差异(两者均为P > 0.05)。晚期视网膜色素上皮细胞撕裂眼在撕裂前明显低于对照组(55.566.9letters;P < 0.001)。在撕裂后视力并没有明显下降,但与所有终点的对照组相比,视力仍在下降。早期和晚期视网膜色素上皮细胞撕裂眼在抗血管内皮生长因子治疗后接受的注射次数多于控制眼。

结论:视网膜色素上皮撕裂情况不同时间下表现不同。与撕裂本身相比,受抗血管内皮生长因子治疗撕裂影响的眼睛的长期视觉效果可能更多地与患者对治疗的反应有关。

PURPOSE:To investigate when retinal pigment epithelium (RPE) tears occur and their associated treatment patterns and long-term visual outcomes in patients with neovascular age-related macular degeneration (nAMD) during anti-vascular endothelial growth factor (VEGF) treatment.DESIGN:Case-control analysis from a prospectively designed observational database.PARTICIPANTS:Treatment-na ve eyes enrolled in the Fight Retina Blindness! observational study that commenced anti-VEGF treatment for nAMD between January 2006 and January 2017 were identified. Cases were defined as eyes in which an RPE tear developed during treatment. Three control eyes per case were matched for age, baseline visual acuity (VA), lesion size, treatment duration before tearing, and duration of follow-up.METHODS:Cases were classified as having early or late tears using a segmented regression model. Baseline characteristics were compared between the 2 groups. Comparisons of VA and injections received between tear eyes and control eyes were performed at baseline, before and immediately after the tear, and then 12 and 24 months later. Visual acuity also was compared among different visits within each group.MAIN OUTCOME MEASURES:Visual acuity, time to tear, and injections received.RESULTS:Fifty-five cases and 165 matched control eyes were included. The segmented regression estimated a breakpoint for the time to tear at 182 days. We therefore defined eyes as having early tears if they tore before the breakpoint (38/55 eyes [69%]), and as late tears if they tore afterward (17/55 eyes [31%]). Baseline VA was significantly lower in early compared with late tears (53.6 vs. 63.4 letters; P = 0.009). Visual acuity had improved in early tears before the tear (+5.6 letters from baseline; P = 0.01), decreased immediately after the tear (-8.3 letters; P = 0.002), then recovered with no difference compared with control eyes 12 and 24 months later (P > 0.05 for both). Late tear eyes had significantly lower VA than control eyes before tearing (55.5 vs. 66.9 letters; P < 0.001). Visual acuity did not decrease significantly after the tear, but continued to decline compared with control eyes at all end points. Both early and late tear eyes received more injections than control eyes after tearing.CONCLUSIONS:Retinal pigment epithelium tears act differently depending on when they occur. Long-term visual outcomes in eyes affected by RPE tearing may be related more to the patient's response to therapy than to the tear itself.


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