玻璃体腔注射雷珠单抗治疗湿性老年性黄斑变性的临床疗效
摘要
目的对比不同给药方案(玻璃体腔内注射雷珠单抗)治疗湿性老年性黄斑变性(wAMD)的疗效差异,探讨影响再治疗时机的因素。方法选择32例(32只眼)wAMD患者随机分为两组,A组:每月进行玻璃体腔内注射Lucentis 0.5 mg 1次。B组:最初每月1次进行玻璃体腔注射Lucentis 0.5 mg,连续3个月,后续再根据再治疗标准决定是否注药。随访时间为12个月。结果两组组间平均最佳矫正视力(BCVA)、黄斑中央区平均视网膜厚度(CMT)、黄斑中央区平均视网膜厚度(CMT)、平均病灶区视网膜厚度(CLT)、眼底荧光造影(FFA)5 min时视网膜新生血管渗漏面积(S)差异无统计学意义(P均>0.05)。两组注药次数差异有统计学意义(P<0.05)。再治疗影响标准中光学相干断层扫描(OCT)检查结果所占比较视力标准所占比高。结论两种给药方案(玻璃体腔内注射雷珠单抗)治疗wAMD均安全有效。评价病灶活动性决定注药时机时,OCT检查结果较视力更敏感。
引文
1 Ferris FL 3rd,Fine SL,Hyman L.Age-related macular degeneration and blindness due to neovascular maculopathy[J].Arch Ophthalmol,1984;102(11):1640-2.
2 邹海东,张皙,许迅,等.上海市静安区曹家渡街道年龄相关性黄斑变性的患病率调查[J].眼科杂志,2005;41(1):15-9.
3 中华医学会眼科学分会眼底病学组中国老年性黄斑变性临床指南与临床路径制订委员会.中国老年性黄斑变性临床诊断治疗路径[J].中华眼底病杂志,2013;29(4):343-55.
4 黎晓新.普及推广“中国老年性黄斑变性临床诊断治疗路径”,规范老年性黄斑变性的诊断治疗[J].中华眼底病杂志,2013;29(4):341-2.
5 Carneiro AM,Mendon LS,Falc? MS,et al.Comparative study of 1+PRN ranibizumab versus bevacizumab in the clinical setting[J].Clin Ophthalmol,2012;6:1149-57.
6 Fung AE,Lalwani GA,Rosenfeld PJ,et al.An optical coherence tomography-guided,variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration[J].Am J Ophthalmol,2007;143(4):566-83.
7 Lalwani GA,Rosenfeld PJ,Fung AE,et al.A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration year 2 of the PrONT0 Study[J].Am J Ophthalmol,2009;148(1):43-58.
8 Daniel Pauleikhoff,Bernd Kirchhof.Retreatment criteria in anti-VEGF therapy of exudative AMD:critical analysis of present regimes and new morphological definition of "lesion activity"[J].Graefes Arch Clin Exp Ophthalmol,2011;249(5):631-2.
9 Spielberg L,Leys A.Treatment of neovascular age-related macular degeneration with a variable ranibizumab dosing regimen and one-time reduced-fluence photodynamic therapy:the TORPEDO trial at 2 years.Graefes [J].Arch Clin Exp Ophthalmol,2010;248(7):943-56.
10 Gupta B,Adewoyin T,Patel SK,et al.Comparison of two intravitreal ranibizumab treatment schedules for neovascular age-related macular degeneration[J].Br J Ophthalmol,2011;95(3):386-90.
11 Ritter M,Simader C,Bolz M,et al.Intraretinal cysts are the most relevant prognostic biomarker in neovascular age-related macular degeneration independent of the therapeutic strategy.[J].Br J Ophthalmol,2014;98(12):1629-35.
12 Ores R,Puche N,Querques G,et al.Gray hyper-reflective subretinal exudative lesions in exudative age-related macular degeneration[J].Am J Ophthalmol,2014;158(2):354-61.
13 Byun YJ,Lee SJ,Koh HJ.Predictors of response after intravitreal bevacizumab injection for neovascular age-related macular degeneration[J].Jpn J Ophthalmol,2010;54(6):571-7.
14 Schmidt-Erfurth U,Leitgeb RA,Michels S,et al.Three-dimensional ultrahigh-resolution optical coherence tomography of macular diseases[J].Invest Ophthalmol Vis Sci,2005;46(9):3393-402.
15 Golbaz I,Ahlers C,Stock G,et al.Quantification of the therapeutic response of intraretinal,subretinal,and subpigment epithelial compartments in exudative AMD during anti-VEGF therapy[J].Invest Ophthalmol Vis Sci,2011;52(3):1599-605.
16 Schmidt-Erfurth U,Waldstein SM,Deak GG,et al.Pigment epithelial detachment followed by retinal cystoid degeneration leads to vision loss in treatment of neovascular age-related macular degeneration[J].Ophthalmology,2015;122(4):822-4.
17 Gharbiya M,Parisi F,Cruciani F,et al.Intravitreal anti-vascular endothelial growth factor for retinal angiomatous proliferation in treatment-naive eyes:long-term functional and anatomical results using a modified PrONTO-style regimen[J].Retina,2014;34(2):298-305.
18 Varshney N,Jain A,Chan V,et al.Anti-VEGF response in macular hemorrhage and incidence of retinal pigment epithelial tears[J].Can J Ophthalmol,2013;48(3):210-5.
19 袁志刚,颜华.玻璃体黄斑粘连与渗出型老年性黄斑变性[J].中华眼底病杂志,2011;27(6):602-3.
20 Lazzeri S,Figus M,Sartini MS,et al.Intravitreal ranibizumab for predominantly hemorrhagic choroidal neovascularization in age-related macular degeneration[J].Ophthalmologica,2015;233(2):74.
2 邹海东,张皙,许迅,等.上海市静安区曹家渡街道年龄相关性黄斑变性的患病率调查[J].眼科杂志,2005;41(1):15-9.
3 中华医学会眼科学分会眼底病学组中国老年性黄斑变性临床指南与临床路径制订委员会.中国老年性黄斑变性临床诊断治疗路径[J].中华眼底病杂志,2013;29(4):343-55.
4 黎晓新.普及推广“中国老年性黄斑变性临床诊断治疗路径”,规范老年性黄斑变性的诊断治疗[J].中华眼底病杂志,2013;29(4):341-2.
5 Carneiro AM,Mendon LS,Falc? MS,et al.Comparative study of 1+PRN ranibizumab versus bevacizumab in the clinical setting[J].Clin Ophthalmol,2012;6:1149-57.
6 Fung AE,Lalwani GA,Rosenfeld PJ,et al.An optical coherence tomography-guided,variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration[J].Am J Ophthalmol,2007;143(4):566-83.
7 Lalwani GA,Rosenfeld PJ,Fung AE,et al.A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration year 2 of the PrONT0 Study[J].Am J Ophthalmol,2009;148(1):43-58.
8 Daniel Pauleikhoff,Bernd Kirchhof.Retreatment criteria in anti-VEGF therapy of exudative AMD:critical analysis of present regimes and new morphological definition of "lesion activity"[J].Graefes Arch Clin Exp Ophthalmol,2011;249(5):631-2.
9 Spielberg L,Leys A.Treatment of neovascular age-related macular degeneration with a variable ranibizumab dosing regimen and one-time reduced-fluence photodynamic therapy:the TORPEDO trial at 2 years.Graefes [J].Arch Clin Exp Ophthalmol,2010;248(7):943-56.
10 Gupta B,Adewoyin T,Patel SK,et al.Comparison of two intravitreal ranibizumab treatment schedules for neovascular age-related macular degeneration[J].Br J Ophthalmol,2011;95(3):386-90.
11 Ritter M,Simader C,Bolz M,et al.Intraretinal cysts are the most relevant prognostic biomarker in neovascular age-related macular degeneration independent of the therapeutic strategy.[J].Br J Ophthalmol,2014;98(12):1629-35.
12 Ores R,Puche N,Querques G,et al.Gray hyper-reflective subretinal exudative lesions in exudative age-related macular degeneration[J].Am J Ophthalmol,2014;158(2):354-61.
13 Byun YJ,Lee SJ,Koh HJ.Predictors of response after intravitreal bevacizumab injection for neovascular age-related macular degeneration[J].Jpn J Ophthalmol,2010;54(6):571-7.
14 Schmidt-Erfurth U,Leitgeb RA,Michels S,et al.Three-dimensional ultrahigh-resolution optical coherence tomography of macular diseases[J].Invest Ophthalmol Vis Sci,2005;46(9):3393-402.
15 Golbaz I,Ahlers C,Stock G,et al.Quantification of the therapeutic response of intraretinal,subretinal,and subpigment epithelial compartments in exudative AMD during anti-VEGF therapy[J].Invest Ophthalmol Vis Sci,2011;52(3):1599-605.
16 Schmidt-Erfurth U,Waldstein SM,Deak GG,et al.Pigment epithelial detachment followed by retinal cystoid degeneration leads to vision loss in treatment of neovascular age-related macular degeneration[J].Ophthalmology,2015;122(4):822-4.
17 Gharbiya M,Parisi F,Cruciani F,et al.Intravitreal anti-vascular endothelial growth factor for retinal angiomatous proliferation in treatment-naive eyes:long-term functional and anatomical results using a modified PrONTO-style regimen[J].Retina,2014;34(2):298-305.
18 Varshney N,Jain A,Chan V,et al.Anti-VEGF response in macular hemorrhage and incidence of retinal pigment epithelial tears[J].Can J Ophthalmol,2013;48(3):210-5.
19 袁志刚,颜华.玻璃体黄斑粘连与渗出型老年性黄斑变性[J].中华眼底病杂志,2011;27(6):602-3.
20 Lazzeri S,Figus M,Sartini MS,et al.Intravitreal ranibizumab for predominantly hemorrhagic choroidal neovascularization in age-related macular degeneration[J].Ophthalmologica,2015;233(2):74.