Evaluation of Injection Frequency and Visual Acuity Outcomes for Ranibizumab Monotherapy in Exudative Age-related Macular Degeneration
Evaluation of Injection Frequency and Visual Acuity Outcomes for Ranibizumab Monotherapy in Exudative Age-related Macular Degeneration
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DOI：
10.1016/j.ophtha.2009.05.033
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发表时间：
2009-09-01
期刊：
影响因子：
13.7
通讯作者：
Kaiser, Peter K.
中科院分区：
文献类型：
--
作者：
Dadgostar, Hajir;Ventura, Alexandre A. C. M.;Kaiser, Peter K.
目的：评估玻璃体内注射雷珠单抗治疗渗出性年龄相关性黄斑变性（AMD）的视力结果，并研究注射频率与该情况下视力结果之间的关系。设计：回顾性，干预性病例系列。参与者：共有131只接受雷珠单抗单药治疗的初治渗出性AMD眼睛。玻璃体内给予雷珠单抗，根据临床检查和光学相干断层扫描（OCT）的指导下，按需进行。由主治医生评价OCT扫描是否存在视网膜内液体、视网膜下液体、视网膜内囊肿或色素上皮脱离尺寸增加。临床数据，包括视力（VA），脉络膜新生血管病变形态，治疗过程中进行了回顾性analysis.Main结果测量：平均变化最佳矫正Snellen VA.Results：平均年龄为81.3岁，平均随访时间为12 +/- 4.3个月（最低6个月，中位数12个月），平均注射次数为5.2 +/- 2.8。整个人群的平均基线Snellen VA为20/110，在6个月（20/80; P = 0.0002）和末次随访（20/90; P = 0.0066）时显著改善。在6个月时，31%的眼睛获得了至少3行VA，90.5%避免了3行的损失。平均而言，在开始治疗后，需要3.0次注射和3.5个月才能在OCT上实现“干燥”或“平坦”黄斑。OCT上视网膜内和视网膜下液体的分辨率与视力改善程度无关。接受更频繁注射的眼睛（定义为3条视力线，而间隔>2个月组为15.9%（P = 0.011）。在接受按需注射雷珠单抗治疗渗出性AMD的人群中，视力改善与接受注射的频率有关，但与OCT对液体的分辨率无关。所需的基础可能导致治疗不足和明显较少的视觉增益。
Objective: To evaluate the visual outcomes for intravitreal ranibizumab administered on an as-needed basis for exudative age-related macular degeneration (AMD) and to investigate the relationship between injection frequency and visual outcome in this setting.Design: Retrospective, interventional case series.Participants: A total of 131 eyes with treatment-naive, exudative AMD undergoing ranibizumab monotherapy.Methods: Intravitreal ranibizumab was administered on an as-needed basis guided by clinical examination and optical coherence tomography (OCT). The OCT scans were evaluated by the treating physicians for the presence of intraretinal fluid, subretinal fluid, intraretinal cysts, or increasing pigment epithelial detachment size. Clinical data including visual acuity (VA), choroidal neovascularization lesion morphology, and treatment course were collected retrospectively for analysis.Main Outcome Measures: Mean change in best-corrected Snellen VA.Results: The mean age was 81.3 years, mean follow-up was 12 +/- 4.3 months (minimum 6 months, median 12 months), and mean number of injections was 5.2 +/- 2.8. Mean baseline Snellen VA for the entire population was 20/110 and significantly improved at 6 months (20/80; P = 0.0002) and at last follow-up (20/90; P = 0.0066). At 6 months, 31% of eyes had gained at least 3 lines of VA and 90.5% had avoided loss of 3 lines. On average, it took 3.0 injections and 3.5 months to achieve a "dry" or "flat" macula on OCT after initiating treatment. Resolution of intra- and subretinal fluid on OCT did not correlate with the degree of vision improvement. Eyes receiving more frequent injections (defined as 3 lines of vision compared with 15.9% in the >2 months interval group (P = 0.011).Conclusions: In a population receiving as-needed injections of ranibizumab for exudative AMD, visual improvement was related to the frequency of injections received but not to the resolution of fluid by OCT. Treatment with ranibizumab on a strictly as-needed basis may result in undertreatment and significantly less visual gain.