The Neovascular Age-Related Macular Degeneration Database Report 2: Incidence, Management, and Visual Outcomes of Second Treated Eyes
The Neovascular Age-Related Macular Degeneration Database Report 2: Incidence, Management, and Visual Outcomes of Second Treated Eyes
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DOI：
10.1016/j.ophtha.2014.04.026
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发表时间：
2014-10-01
期刊：
影响因子：
13.7
通讯作者：
Tufail, Adnan
中科院分区：
文献类型：
--
作者：
Zarranz-Ventura, Javier;Liew, Gerald;Tufail, Adnan
目的：研究英国国家卫生服务中心新生血管性老年性黄斑变性(NAMD)患者接受雷尼比珠单抗治疗后二次治疗眼的特点。设计：多中心国家NAMD数据库研究。研究对象：接受雷尼比单抗注射的11 135名患者的12,951只未接受治疗的眼睛。方法：从14个中心远程提取电子病历系统中长达5年的常规匿名数据。参与中心仅使用雷尼比珠单抗治疗NAMD(每月注射3次，然后每月访问和自然再治疗的负荷期)。最小数据集包括：年龄、基线和随后所有就诊时的最小分辨角度(LogMAR)的对数、视力(VA)和注射次数。主要观察指标：基线、3年的变化和实际视力，以及治疗和临床就诊的次数。结果：在研究期间，11 135名患者中有1816人(16.3%)接受了对侧眼的治疗。第一次治疗的平均基线和最终视力分别为0.66(标准差，0.32)和0.65(0.40)，第二次治疗的平均基线和最终视力分别为0.41(0.34)和0.56(0.40)。第一次治疗眼和第二次治疗眼在负荷期后的视力丢失率相似(0.03和0.05logMAR单位/年)。排除基线视力低于20/200的对侧眼，将分析局限于NAMD的风险眼，第二眼受累的比率为每年14.0%(42%/3年)。第1年、第2年和第3年的平均注射/就诊次数相似(5.6/8.2、3.9/8.0、3.8/8.2和5.5/8.7、3.6/9.4和3.8/9.1)。结论：NAMD的第二治疗眼在治疗开始时具有更好的基线视力，在所有时间点都没有明显的视力提高，但至少在3年内保持了更好的视力，使其成为更重要的眼功能。这些数据突显了第二只眼睛受累的沉重负担，几乎一半的眼睛面临风险，需要在3年内进行双边治疗，而且需要定期监测对眼，以获得最佳的视觉效果，这在理论上可能会减少延长监测方案的好处。(C)2014年由美国眼科学会颁发。
Purpose: To study the characteristics of second treated eyes in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab in the United Kingdom National Health Service.Design: Multicenter national nAMD database study. Participants: Twelve thousand nine hundred fifty-one treatment-naive eyes of 11 135 patients receiving 92 976 ranibizumab injections.Methods: Up to 5 years of routinely collected, anonymized data within electronic medical record systems were extracted remotely from 14 centers. Participating centers exclusively used ranibizumab to treat nAMD (loading phase of 3 monthly injections followed by monthly visits and pro re nata re-treatment). The minimum data set included: age, logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) at baseline and at all subsequent visits, and injection episodes.Main Outcome Measures: Baseline, change and actual VA over 3 years, and number of treatments and clinic visits.Results: During the study, 1816 (16.3%) of the 11 135 patients received treatment to the fellow eye. Mean baseline and final VA were 0.66 (standard deviation, 0.32) and 0.65 (0.40) for first treated eyes and 0.41 (0.34) and 0.56 (0.40) for second treated eyes. The rate of VA loss after the loading phase was similar in first and second treated eyes (0.03 and 0.05 logMAR units/year). When fellow eyes with baseline VA worse than 20/200 were excluded to restrict analyses to eyes at risk of nAMD, the rate of second-eye involvement was 14.0% per year (42%/3 years). Mean number of injections/visits in years 1, 2, and 3 were similar for first and second treated eyes (5.6/8.2, 3.9/8.0, 3.8/8.2 and 5.5/8.7, 3.6/9.4, and 3.8/9.1, respectively).Conclusions: Second treated eyes with nAMD commence treatment with better baseline VA, do not show significant vision gain but maintain better VA than first treated eyes at all time points for at least 3 years, making them the more important eye functionally. These data highlight the high burden of second eye involvement, with almost half of all eyes at risk requiring bilateral treatment by 3 years, and the need for regular monitoring of fellow eyes for best visual outcomes which theoretically may reduce the benefits of extended monitoring regimens. (C) 2014 by the American Academy of Ophthalmology.