Treat-and-Extend Regimen with Aflibercept for Neovascular Age-Related Macular Degeneration Efficacy and Macular Atrophy Development
Treat-and-Extend Regimen with Aflibercept for Neovascular Age-Related Macular Degeneration Efficacy and Macular Atrophy Development
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DOI：
10.1016/j.oret.2017.09.002
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发表时间：
2018-05-01
影响因子：
4.5
通讯作者：
Akiyama, Hideo
中科院分区：
文献类型：
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作者：
Matsumoto, Hidetaka;Morimoto, Masahiro;Akiyama, Hideo
目的：评价玻璃体内注射阿普利赛特对治疗初治的新生血管性老年性黄斑变性(AMD)和黄斑萎缩的影响。设计：回顾性干预性病例系列。研究对象：治疗初诊的AMD患者137只眼，其中典型AMD伴典型脉络膜新生血管(CNV)18只眼，典型AMD隐匿性CNV 44只眼，息肉状脉络膜血管病变58只眼，方法：回顾新生血管性AMD患者的临床资料，连续3个月玻璃体腔内注射阿普利赛特，并进行相应的影像检查。主要观察指标：最佳矫正视力(BCVA)、中央黄斑厚度(CMT)、中央脉络膜厚度(CCT)及黄斑区黄斑萎缩程度。结果：1、2年后，各亚型AMD黄斑萎缩程度均明显缩小，CMT、CCT明显增大。在基线时，RAP的黄斑萎缩程度比其他亚型更严重；2年后，RAP的黄斑萎缩扩大也最大，并与CCT呈负相关(rS=-0.72；P<；0.01)。最佳矫正视力在1年和2年后在除RAP以外的所有亚型中都有显著改善。RAP组术后1年BCVA明显改善，2年后改善幅度无统计学意义。结论：玻璃体内注射AFLIFECT可有效改善新生血管性AMD的BCVA，减轻渗出性改变。然而，在RAP中，治疗过程中脉络膜变薄可能会加速黄斑萎缩的扩大，从而降低2年后BCVA的改善。(C)2017年度美国眼科学会
Purpose: To evaluate the effects of intravitreal injection of aflibercept using a treat-and-extend dosing regimen on treatment-naive neovascular age-related macular degeneration (AMD) and the development of macular atrophy.Design: Retrospective, interventional case series.Participants: Eyes (n = 137) with treatment-naive neovascular AMD, including 18 eyes with typical AMD with classic choroidal neovascularization (CNV), 44 eyes with typical AMD with occult CNV, 58 eyes with polypoidal choroidal vasculopathy, and 17 eyes with retinal angiomatous proliferation (RAP).Methods: Clinical records of eyes with neovascular AMD that underwent 3 consecutive monthly intravitreal injections of aflibercept followed by a treat-and-extend dosing regimen were reviewed, and the corresponding imaging studies were analyzed.Main Outcome Measures: Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and the extent of macular atrophy in the macular area during a 2-year follow-up period.Results: In all subtypes after 1 and 2 years, CMT and CCT were reduced significantly, whereas macular atrophy showed significant enlargement. At baseline, the extent of macular atrophy was greater in RAP than other subtypes; after 2 years, the macular atrophy enlargement was also greatest in RAP and correlated negatively with CCT (rs = -0.72; P < 0.01). Best-corrected visual acuity showed significant improvement after 1 and 2 years in all subtypes other than RAP. In RAP, BCVA was improved significantly after 1 year, but the magnitude of this improvement lost statistical significance after 2 years.Conclusions: Treat-and-extend with intravitreal aflibercept may be effective for improving BCVA and ameliorating exudative changes in neovascular AMD. However in RAP, choroidal thinning during the treatment regimen may accelerate enlargement of macular atrophy, thereby diminishing the improvement in BCVA after 2 years. (C) 2017 by the American Academy of Ophthalmology