Macular atrophy in patients with long-term anti-VEGF treatment for neovascular age-related macular degeneration
Macular atrophy in patients with long-term anti-VEGF treatment for neovascular age-related macular degeneration
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DOI：
10.1111/aos.13157
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发表时间：
2016-12-01
影响因子：
3.4
通讯作者：
Zinkernagel, Martin S.
中科院分区：
文献类型：
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作者：
Munk, Marion R.;Ceklic, Lala;Zinkernagel, Martin S.
PurposeTo确定的患病率和进展的黄斑萎缩（MA）在新生血管性年龄相关性黄斑变性（AMD）患者长期抗血管内皮生长因子（VEGF）治疗，并确定危险factors.MethodThis回顾性研究包括患者与新生血管性AMD和30抗VEGF注射。使用近红外和光谱域光学相干断层扫描（SD-OCT）测量黄斑萎缩（MA）。使用平方根转换估计年生长率，以调整基线面积并允许生长率线性化。多元回归与赤池信息标准（AIC）作为模型选择criterion被用来估计各种参数对MA area.ResultsForty-nine眼（47例患者，平均年龄7714）的影响，包括平均48 +/- 13玻璃体内抗VEGF注射（ranibizumab：37 +/- 11，aflibercept：11 +/- 6，平均注射次数/年8 +/- 2.1）超过平均治疗期6.2 +/- 1.3years（范围4-8.5）。平均最佳矫正视力从基线（=治疗开始）时的57 +/- 17个字母改善至末次随访时的60 +/- 16个字母。在初始测量时，脉络膜新生血管（CNV）边界内外的MA患病率为45%，并增加至74%。平均MA面积从CNV边界内的1.8 +/- 2.7mm（2）和CNV边界外的0.5 +/- 0.98mm（2）分别增加到2.7 +/- 3.4mm（2）和1.7 +/- 1.8mm（2）。多变量回归确定玻璃体后脱离（PVD）和视网膜内囊肿（IRC）的存在/发展是总MA大小的重要因素（R-2 = 0.16，p=0.02）。CNV边界外的黄斑萎缩（MA）区域最好通过网状假性玻璃疣（RPD）和IRC的存在来解释（R-2 = 0.24，p=0.02）。结论大多数患者在长期抗VEGF治疗后表现出MA。网状假性玻璃疣（RPD）、IRC和PVD，但注射次数或治疗持续时间似乎与MA大小无关。
PurposeTo identify the prevalence and progression of macular atrophy (MA) in neovascular age-related macular degeneration (AMD) patients under long-term anti-vascular endothelial growth factor (VEGF) therapy and to determine risk factors.MethodThis retrospective study included patients with neovascular AMD and 30 anti-VEGF injections. Macular atrophy (MA) was measured using near infrared and spectral-domain optical coherence tomography (SD-OCT). Yearly growth rate was estimated using square-root transformation to adjust for baseline area and allow for linearization of growth rate. Multiple regression with Akaike information criterion (AIC) as model selection criterion was used to estimate the influence of various parameters on MA area.ResultsForty-nine eyes (47 patients, mean age 7714) were included with a mean of 48 +/- 13 intravitreal anti-VEGF injections (ranibizumab:37 +/- 11, aflibercept:11 +/- 6, mean number of injections/year 8 +/- 2.1) over a mean treatment period of 6.2 +/- 1.3years (range 4-8.5). Mean best-corrected visual acuity improved from 57 +/- 17 letters at baseline (= treatment start) to 60 +/- 16 letters at last follow-up. The MA prevalence within and outside the choroidal neovascularization (CNV) border at initial measurement was 45% and increased to 74%. Mean MA area increased from 1.8 +/- 2.7mm(2) within and 0.5 +/- 0.98mm(2) outside the CNV boundary to 2.7 +/- 3.4mm(2) and 1.7 +/- 1.8mm(2), respectively. Multivariate regression determined posterior vitreous detachment (PVD) and presence/development of intraretinal cysts (IRCs) as significant factors for total MA size (R-2 = 0.16, p=0.02). Macular atrophy (MA) area outside the CNV border was best explained by the presence of reticular pseudodrusen (RPD) and IRC (R-2 = 0.24, p=0.02).ConclusionA majority of patients show MA after long-term anti-VEGF treatment. Reticular pseudodrusen (RPD), IRC and PVD but not number of injections or treatment duration seem to be associated with the MA size.