Baseline predictors for one-year visual outcomes with ranibizumab or bevacizumab for neovascular age-related macular degeneration.
Baseline predictors for one-year visual outcomes with ranibizumab or bevacizumab for neovascular age-related macular degeneration.
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DOI：
10.1016/j.ophtha.2012.07.042
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发表时间：
2013-01
期刊：
影响因子：
13.7
通讯作者：
Comparison of Age-related Macular Degeneration Treatments Trials Research Group
中科院分区：
文献类型：
--
作者：
Ying GS;Huang J;Maguire MG;Jaffe GJ;Grunwald JE;Toth C;Daniel E;Klein M;Pieramici D;Wells J;Martin DF;Comparison of Age-related Macular Degeneration Treatments Trials Research Group
确定雷珠单抗或贝伐单抗治疗新生血管性年龄相关性黄斑变性（AMD）后1年视力（VA）结局的基线预测因素。AMD治疗比较试验中的队列研究。1105例新生血管性AMD受试者，基线VA 20/25至20/320，1年时测量VA。参与者被随机分配到雷珠单抗或贝伐单抗，每月或按需安排。蒙眼阅片者评价眼底形态和光学相干断层扫描（OCT）特征。VA采用电子视力测试进行测量。使用回归技术确定独立的预测因子。1年时VA评分、VA评分较基线的变化和≥3线增益。一年时，平均VA评分为68个字母，较基线平均改善7个字母，28%的参与者获得≥3线。年龄较大、脉络膜新生血管（CNV）面积较大和视网膜色素上皮（RPE）升高与视力较差（所有p<0.005）、视力增加较少（所有p<0.02）和增加≥3行的比例较低（所有p<0.04）相关。较好的基线视力与1年时较好的视力、较低的视力增加和较低的增加≥3行的比例相关（所有p<0.0001）。与隐匿性病变相比，主要或轻微经典病变的VA更差（66 vs. 69字母，p=0.0003）。视网膜血管瘤性视网膜炎（RAP）病变与VA增加更多（10 vs. 7字母，p=0.03）和增加≥3行的比例更高（比值比=1.9，95%置信区间：1.2 - 3.1）相关。地图样萎缩（GA）与VA较差相关（64 vs. 68字母，p=0.02）。总中心凹厚度在第二四分位数（325 - 425微米）的眼睛具有最佳视力（p=0.01），并且最有可能获得≥3行（p=0.004）。不同治疗组的预测因素无差异。对于所有治疗组，年龄较大、基线VA较好、CNV面积较大、主要或最小经典病变、无RAP病变、存在GA、总中心凹厚度较大和OCT显示RPE升高与1年时VA改善较少独立相关。
To determine baseline predictors of visual acuity (VA) outcomes at 1 year after treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD). Cohort study within the Comparison of AMD Treatments Trials. 1105 participants with neovascular AMD, baseline VA 20/25 to 20/320, and VA measured at 1 year. Participants were randomly assigned to ranibizumab or bevacizumab on either a monthly or as-needed schedule. Masked readers evaluated fundus morphology, and features on optical coherence tomography (OCT). VA was measured using electronic visual acuity testing. Independent predictors were identified using regression techniques. VA score, VA score change from baseline, and ≥3-line gain at 1 year. At one year, the mean VA score was 68 letters, mean improvement from baseline was 7 letters, and 28% of participants gained ≥3-line. Older age, larger area of choroidal neovascularization (CNV), and elevation of retinal pigment epithelium (RPE) were associated with worse VA (all p<0.005), less gain in VA (all p<0.02) and a lower proportion gaining ≥3-lines (all p<0.04). Better baseline VA was associated with better VA at 1 year, less gain in VA, and a lower proportion gaining ≥3-lines (all p<0.0001). Predominantly or minimally classic lesions were associated with worse VA than occult lesions (66 vs. 69 letters, p=0.0003). Retinal Angiomatous Proliferans (RAP) lesions were associated with more gain in VA (10 vs. 7 letters, p=0.03) and a higher proportion gaining ≥3-lines (odds ratio=1.9, 95% confidence interval: 1.2 – 3.1). Geographic atrophy (GA) was associated with worse VA (64 vs. 68 letters, p=0.02). Eyes with total foveal thickness in the 2nd quartile (325 – 425 microns) had the best visual acuity (p=0.01) and were most likely to gain ≥3 lines (p=0.004). Predictors did not vary by treatment group. For all treatment groups, older age, better baseline VA, larger CNV area, predominantly or minimally classic lesion, absence of RAP lesion, presence of GA, greater total fovea thickness and RPE elevation on OCT were independently associated with less improvement in VA at 1 year.
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