息肉状脉络膜血管病变抗VEGF治疗后病灶活动性相关因素分析
|
摘要
目的分析息肉状脉络膜血管病变(PCV)抗血管内皮生长因子(VEGF)治疗后病灶活动性相关因素。方法回顾性观察研究。吲哚菁绿血管造影(ICGA)检查确诊的PCV患者60例(60只眼)纳入研究。所有患者均行连续3个月每个月注射1次抗VEGF药物治疗后视网膜层间或层下积液完全吸收,至少随访24个月以上。根据起始治疗3个月后复查病灶是否再活动的情况分为复发组和未复发组。复发组44例中,男性28例,女性16例,平均年龄(60.50±7.46)岁,平均logMAR BCVA为(0.79±0.20),平均中心凹视网膜厚度(CRT)为(372.82±84.70)μm,平均不伴异常分支血管网(BVN)面积为(3.35±1.06)mm~2,平均病灶的最大线性尺寸(GLD)为(3.05±1.20)mm,息肉位置位于中心凹、视网膜色素上皮脱离(RPED)、视网膜层间积液(IRF)或视网膜下液(SRF)、视网膜黄斑下出血(SMH)≥1 PD者分别为18、18、10、15只眼。未复发组16例中,男性11例,女性5例,平均年龄(64.19±13.26)岁,平均logMAR BCVA为(0.77±0.23),平均CRT为(361.94±66.21)μm,平均BVN面积为(2.91±0.93)mm~2,平均GLD为(2.06±0.62)mm,息肉位置位于中心凹、RPED、IRF或SRF、SMH≥1 PD者分别为7、11、9、10只眼。单因素分析及多元Cox回归分析比较两组间基线时各参数。结果 24个月随访期间,复发组起始治疗后平均复发时间间隔为(2.92±2.42)个月,平均注射次数为(6.61±2.12)次。两组间性别、平均年龄、logMAR BCVA、平均CRT、息肉位置、BVN面积、RPED差异无统计学意义(P>0.05),多元Cox回归分析结果显示,治疗前存在SMH≥1 PD(P=0.031)、GLD大者(P=0.011)与病灶再活动性相关。结论基线时存在SMH≥1 PD、GLD小的患者经抗VEGF药物治疗后不易复发。
Objective To investigate the factors associated with reactivation of polypoidal choroidal vasculopathy(PCV) after anti-VEGF treatment. Methods This retrospective observational study included 60 patients( 60 eyes) diagnosed with PCV by(Indocynine Green Angiography, ICGA) and treated with three monthly anti-VEGF injections. Only patients who exhibited complete resolution of fluid after initial treatment and were followed up for at least 24 months were enrolled. Patients were divided into 2 groups according to the reactivation status of PCV lesions after 3 months of treatment. The reactive group included 28 males and 16 females(44 eyes), with a mean age of 60.50±7.46 years, a mean central retinal thickness(CRT) of 372.82±84.70 μm, a mean LogMAR best-corrected visual acuity(BCVA) of 0.79±0.20, a mean BVN area of 3.35±1.06 mm2, and a mean GLD of 3.05±1.26 mm. There were 18 eyes with sub-foveal location of the polyp, 18 eyes with pigment epithelial detachment(PED), 10 eyes with intra-retinal retinal fluid(IRF) or subretinal fluids(SRF), and 15 eyes with subretinal hemorrhage(SRH)≥ 1 PD. The non-reactive group included 11 males and 5 females(16 eyes), with a mean age of 64.19±13.26 years, a mean CRT of 361.94±66.21 μm, a mean logMAR BCVA of 0.77±0.23, a mean BVN area of 2.91±0.93 mm~2, and a mean GLD of 2.06±0.62 mm. There were 7 eyes with sub-foveal location of the polyp, 11 eyes with PED, 9 eyes with IRF or SRF, and 10 eyes with SRH ≥1 PD. The baseline characteristics between the two groups were compared using univariate and multiple Cox regression analysis. Results During the 24-month follow-up period, The first reactivation was noted at a mean duration of 2.92 ± 2.42 months after the third anti-VEGF injection in the reactive group, and the mean injections were 6.61±2.12. There was no significant difference in sex, mean age, CRT, logMAR BCVA, location of the polyp, BVN area and RPED between the two groups(P>0.05). Cox regression analysis revealed that presence of SRH ≥1 PD(P=0.031) before treatment, and greater GLD(P=0.011) were associated with reactivation of the PCV lesion. Conclusions Patients with baseline SRH ≥1 PD and greater GLD were less likely to have PCV reactivation after anti-VEGF treatment.
Objective To investigate the factors associated with reactivation of polypoidal choroidal vasculopathy(PCV) after anti-VEGF treatment. Methods This retrospective observational study included 60 patients( 60 eyes) diagnosed with PCV by(Indocynine Green Angiography, ICGA) and treated with three monthly anti-VEGF injections. Only patients who exhibited complete resolution of fluid after initial treatment and were followed up for at least 24 months were enrolled. Patients were divided into 2 groups according to the reactivation status of PCV lesions after 3 months of treatment. The reactive group included 28 males and 16 females(44 eyes), with a mean age of 60.50±7.46 years, a mean central retinal thickness(CRT) of 372.82±84.70 μm, a mean LogMAR best-corrected visual acuity(BCVA) of 0.79±0.20, a mean BVN area of 3.35±1.06 mm2, and a mean GLD of 3.05±1.26 mm. There were 18 eyes with sub-foveal location of the polyp, 18 eyes with pigment epithelial detachment(PED), 10 eyes with intra-retinal retinal fluid(IRF) or subretinal fluids(SRF), and 15 eyes with subretinal hemorrhage(SRH)≥ 1 PD. The non-reactive group included 11 males and 5 females(16 eyes), with a mean age of 64.19±13.26 years, a mean CRT of 361.94±66.21 μm, a mean logMAR BCVA of 0.77±0.23, a mean BVN area of 2.91±0.93 mm~2, and a mean GLD of 2.06±0.62 mm. There were 7 eyes with sub-foveal location of the polyp, 11 eyes with PED, 9 eyes with IRF or SRF, and 10 eyes with SRH ≥1 PD. The baseline characteristics between the two groups were compared using univariate and multiple Cox regression analysis. Results During the 24-month follow-up period, The first reactivation was noted at a mean duration of 2.92 ± 2.42 months after the third anti-VEGF injection in the reactive group, and the mean injections were 6.61±2.12. There was no significant difference in sex, mean age, CRT, logMAR BCVA, location of the polyp, BVN area and RPED between the two groups(P>0.05). Cox regression analysis revealed that presence of SRH ≥1 PD(P=0.031) before treatment, and greater GLD(P=0.011) were associated with reactivation of the PCV lesion. Conclusions Patients with baseline SRH ≥1 PD and greater GLD were less likely to have PCV reactivation after anti-VEGF treatment.
引文
[1] Tittl M.K,Spaide R F.Wong D,et al.Systemic findings associated with central serous chorioretinopathy[J].Am J Ophthalmol,1999,128(1):63-68.
[2] Bhisitkul RB,Winn BJ,Lee OT,et al.Neuroprotective effect of intravitreal triamcinolone acetonide against photoreceptor apoptosis in a rabbit model of subretinal hemorrhage[J].Invest Ophthalmol Vis Sci,2008,49(9):4071-4077.
[3] Notomi S,Hisatomi T,Murakami Y,et al.Dynamic increase in extracellular ATP accelerates photoreceptor cell apoptosis via ligation of P2RX7 in subretinal hemorrhage[J].PLoS One,2013,8(1):53338.
[4] Sato T,Kishi S,Matsumoto H,et al.Comparisons of outcomes with different intervals between adjunctive ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy[J].Am J Ophthalmol,2013,156(1):95-105.
[5] Kim JH,hang YS,Kim JW,et al.Intravitreal anti-vascular endothelial growth factor for submacular hemorrhage from choroidal neovascularization[J].Ophthalmology,2014,121(4):926-935.
[6] Shin JY,Lee JM,Byeon SH.Anti-vascular endothelial growth factor with or without pneumatic displacement for submacular hemorrhage[J].Am J Ophthalmol,2015,159(5):904-914.
[7] Koh A,Lee WK,Chen LJ,et al.EVEREST study:efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy[J].Retina,2012,32(8):1453-1464.
[8] Cheng Y,Shi X,Qu JF,et al.Comparison of the 1-year Outcomes of Conbercept Therapy between Two Different Angiographic Subtypes of Polypoidal Choroidal Vasculopathy[J].Chin Med J (Engl),2016,129(21):2610-2616.
[9] Koizumi H.Kano M.Yamamoto A,et al.Short-term changes in choroidal thickness after aflibercept therapy for neovascular age-related macular degeneration[J].Am J Ophthalmol,2015,159(4):627-633.
[10] Huang Z,Ding Q,Yan M,et al.Short-term efficacy of conbercept and ranibizumab for polypoidal choroidal vasculopathy [J].Retina,2018,38:1-7.
[11] Yiu G,Mahmoud T H.Subretinal hemorrhage[J].Dev Ophthalmol,2014,54:213-222.
[12] Fine HF,Iranmanesh R,Del PLV,et al.Surgical outcomes after massive subretinal hemorrhage secondary to age-related macular degeneration[J].Retina,2010,30(10):1588-1594.
[13] Toth CA,Morse LS,Hjelmeland LM,et al.Fibrin directs early retinal damage after experimental subretinal hemorrhage[J].Arch Ophthalmol,1991,109(5):723-729.
[14] 韦春宜,刘冉,李加青,等.息肉样脉络膜血管病变患者频域光相干断层扫描图像特征与视力预后的相关性观察[J].中华眼底病杂志,2014,30(3):241-244.
[15] Kim JH,Chang YS,Kim CG,et al.Hyperpigmented spots after treatment for submacular hemorrhage secondary to polypoidal choroidal vasculopathy[J].Graefes Arch Clin Exp Ophthalmol,2018,256(3):469-477.
[16] Campochiaro PA.Molecular pathogenesis of retinal and choroidal vascular diseases[J].Prog Retin Eye Res,2015,49:67-81.
[2] Bhisitkul RB,Winn BJ,Lee OT,et al.Neuroprotective effect of intravitreal triamcinolone acetonide against photoreceptor apoptosis in a rabbit model of subretinal hemorrhage[J].Invest Ophthalmol Vis Sci,2008,49(9):4071-4077.
[3] Notomi S,Hisatomi T,Murakami Y,et al.Dynamic increase in extracellular ATP accelerates photoreceptor cell apoptosis via ligation of P2RX7 in subretinal hemorrhage[J].PLoS One,2013,8(1):53338.
[4] Sato T,Kishi S,Matsumoto H,et al.Comparisons of outcomes with different intervals between adjunctive ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy[J].Am J Ophthalmol,2013,156(1):95-105.
[5] Kim JH,hang YS,Kim JW,et al.Intravitreal anti-vascular endothelial growth factor for submacular hemorrhage from choroidal neovascularization[J].Ophthalmology,2014,121(4):926-935.
[6] Shin JY,Lee JM,Byeon SH.Anti-vascular endothelial growth factor with or without pneumatic displacement for submacular hemorrhage[J].Am J Ophthalmol,2015,159(5):904-914.
[7] Koh A,Lee WK,Chen LJ,et al.EVEREST study:efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy[J].Retina,2012,32(8):1453-1464.
[8] Cheng Y,Shi X,Qu JF,et al.Comparison of the 1-year Outcomes of Conbercept Therapy between Two Different Angiographic Subtypes of Polypoidal Choroidal Vasculopathy[J].Chin Med J (Engl),2016,129(21):2610-2616.
[9] Koizumi H.Kano M.Yamamoto A,et al.Short-term changes in choroidal thickness after aflibercept therapy for neovascular age-related macular degeneration[J].Am J Ophthalmol,2015,159(4):627-633.
[10] Huang Z,Ding Q,Yan M,et al.Short-term efficacy of conbercept and ranibizumab for polypoidal choroidal vasculopathy [J].Retina,2018,38:1-7.
[11] Yiu G,Mahmoud T H.Subretinal hemorrhage[J].Dev Ophthalmol,2014,54:213-222.
[12] Fine HF,Iranmanesh R,Del PLV,et al.Surgical outcomes after massive subretinal hemorrhage secondary to age-related macular degeneration[J].Retina,2010,30(10):1588-1594.
[13] Toth CA,Morse LS,Hjelmeland LM,et al.Fibrin directs early retinal damage after experimental subretinal hemorrhage[J].Arch Ophthalmol,1991,109(5):723-729.
[14] 韦春宜,刘冉,李加青,等.息肉样脉络膜血管病变患者频域光相干断层扫描图像特征与视力预后的相关性观察[J].中华眼底病杂志,2014,30(3):241-244.
[15] Kim JH,Chang YS,Kim CG,et al.Hyperpigmented spots after treatment for submacular hemorrhage secondary to polypoidal choroidal vasculopathy[J].Graefes Arch Clin Exp Ophthalmol,2018,256(3):469-477.
[16] Campochiaro PA.Molecular pathogenesis of retinal and choroidal vascular diseases[J].Prog Retin Eye Res,2015,49:67-81.