Influence of pigment epithelial detachment on visual acuity in neovascular age-related macular degeneration

Pigment epithelial detachment (PED), the anatomical separation of the retinal pigment epithelium from the Bruch membrane, is common in many chorioretinal diseases, including neovascular age-related macular degeneration. PED is present in about 30% to 80% of neovascular age-related macular degeneration patients based on the CATT, EXCITE, and VIEW studies. The influence of PED on visual acuity is controversial as a result of inconsistent results reported by various studies. With advances in imaging technologies, it is possible to evaluate not only the presence or absence of PED, but also detailed quantitative parameters, such as height, width, greatest linear diameter, area, volume, and reflectivity within the PED. We performed a comprehensive literature review to evaluate the relationship of PED with visual acuity. In summary, the presence or persistence of a PED may still be compatible with relatively good visual acuity. There is no strong evidence that the presence of a PED or aspects of its morphology has a significant impact on visual acuity. The presence of a PED may be predictive of the need for more regular treatment. More well-designed studies with standardized PED definitions and classifications are needed to evaluate the relationship between PED and visual acuity.     

High-dose ranibizumab therapy for vascularized pigment epithelial detachment

Purpose

The conventional dose of anti-vascular endothelial growth factor treatment may slowly reduce the subretinal fluid and height of a vascularized pigment epithelial detachment (vPED), but rarely leads to its complete resolution. We report a dramatic outcome involving a high dose (2 mg) of ranibizumab for treating vPED.

Methods

This report describes three eyes with vPED that received 2 mg in 0.05 ml of ranibizumab injections on a monthly basis and were followed prospectively. Each patient received a complete ocular examination, including best-corrected standardized ETDRS testing, fundus photography (FP), fluorescein angiography (FA), optical coherent tomography (OCT), and indocyanine-green angiography at baseline. ETDRS and OCT testing were repeated monthly, while FP and FA were performed every 3 months.

Results

Following a single intravitreal injection of 2 mg ranibizumab, there was rapid resolution of the subretinal fluid, haemorrhage, exudates, and flattening of the vPED within 10 days for Case 1, and within 1 month for Case 2 and Case 3.

Conclusion

Rapid and dramatic decrease in the exudative changes and collapse of the vPED may develop after a single injection of high-dose (2 mg) ranibizumab in certain eyes with a vPED. The improvement was maintained with additional monthly injections to 12 months.     

One-year results of combined photodynamic therapy and intravitreal bevacizumab injection for retinal pigment epithelial detachment secondary to age-related macular degeneration

Background  To evaluate the efficacy of combined photodynamic therapy (PDT) and intravitreal bevacizumab injection in eyes with a serous pigment epithelial detachment (PED) associated with age-related macular degeneration (AMD). Methods  Twenty-two eyes with a serous PED exceeding two disc areas associated with AMD with choroidal vascular abnormalities [choroidal neovascularization (n = 10), polypoidal choroidal vasculopathy (n = 9), and retinal angiomatous proliferation (n = 3)] received combined PDT and intravitreal bevacizumab, and were followed about every 6 weeks for more than 1 year. Additional treatments were given for residual or recurrent lesions. The main outcome measures were changes in the PED height measured by optical coherence tomography, and the best-corrected visual acuity. Results  After one treatment, the PED resolved in 12 eyes (55%) and the PED decreased in ten eyes (45%). There was no recurrence in eight (36%) eyes; however, PED recurred in 14 eyes. At 1 year, the average PED height decreased to 413 microns from the baseline 751 microns (p < 0.001). Twenty eyes (91%) had improved or stabilized vision; two eyes had decreased vision due to a retinal pigment epithelial tear and subretinal hemorrhage. Conclusions  Combined PDT and intravitreal bevacizumab may decrease the PED height and stabilize visual acuity at 1 year. The authors have no proprietary and financial interest in any aspect of this report.     

Retinal pigment epithelial tear following intravitreal ranibizumab injections for neovascular age-related macular degeneration

Background To report the development of retinal pigment epithelial (RPE) tear after intravitreal injection of ranibizumab (Lucentis, Novartis, Basel, Switzerland). Methods Case report with presentation of the fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) findings. Results A 70-year-old man received intravitreal injections of ranibizumab for the treatment of occult choroidal neovascularisation (CNV) with fibrovascular pigment epithelial detachment due to age-related macular degeneration. One day after the third intravitreal ranibizumab injection, fundus examination showed a RPE defect at the foveal region. FA and OCT confirmed the presence of RPE tear sparing the fovea. No further progression of the RPE tear was observed after withholding subsequent ranibizumab injection and his right eye visual acuity remained at 20/100 at 3 months from the last injection. Conclusions As with other anti-vascular endothelial growth factor treatment for CNV, RPE tear might occur after intravitreal ranibizumab injection even after previous uneventful intravitreal injections.     

Spontaneous or secondary to intravitreal injections of anti-angiogenic agents retinal pigment epithelial tears in age-related macular degeneration

AIM:To evaluate the visual function evolution of retinal pigment epithelial (RPE) tears in patients with age-related macular degeneration (AMD) according to type of occurrence [spontaneous or secondary to anti-vascular endothelial growth factor (anti-VEGF) injection] and the topographic location of the tear after a two-year follow-up period.METHODS:A total of 15 eyes of 14 patients with RPE tears in exudative AMD were analyzed retrospectively at the University Eye Clinic of Trieste. Inclusion criteria were:patient age of 50 or older with AMD and RPE tears both spontaneous occurring or post anti-VEGF treatment. Screening included:careful medical history, complete ophthalmological examination, fluorescein angiography (FA), indocyanine green angiography (ICG), autofluorescence and infrared imaging and optical coherence tomography (OCT). Patients were evaluated every month for visual acuity (VA), fundus examination and OCT. Other data reported were:presence of PED, number of injections before the tear, location of the lesion.RESULTS: Mean follow-up was 24wk (SD±4wk). A total of 15 eyes were studied for RPE tear. In 6 cases (40%), the RPE tears occurred within two years of anti-VEGF injections the others occurred spontaneously. In 13 cases (86.6%), the RPE tear was associated with pigment epithelial detachment (PED). In 7 cases (46.6%), the RPE tear occurred in the central area of the retina and involved the fovea. Two lesions were found in the parafoveal region, six in the extra-macular area. In all cases visual acuity decreased at the end of the follow-up period (P<0.01) independently of the type or the topographical location of the lesion.CONCLUSION:RPE tear occurs in exudative AMD as a spontaneous complication or in relation to anti-VEGF injections. Visual acuity decreased significantly and gradually in the follow-up period in all cases. No correlation was found between visual loss and the type of onset or the topographic location of the tears.     

PDT联合ranibizumab玻璃体腔注射治疗年龄相关性黄斑变性合并CNV

目的：观察 PDT 联合玻璃体腔注射 ranibizumab (雷珠单抗)治疗老年性黄斑变性脉络膜新生血管( choroidal neovascularization,CNV)的疗效。
　　方法：将符合纳入标准,经吲哚青绿脉络膜血管造影(indocyanine green angiography, ICGA)、光学相干断层扫描( optical coherence tomography, OCT)检查确诊为黄斑区脉络膜新生血管( CNV)患者27例27眼,经PDT治疗后3~7 d内行 ranibizumab 玻璃体腔注射。观察治疗后1,3,6 mo、末次随访时行最佳矫正视力、FFA、ICGA、OCT 检查及有无并发症发生情况。
　　结果：最佳矫正视力提高17眼(63%),最佳矫正视力稳定6眼(22%),最佳矫正视力下降4眼(15%)。27例27眼治疗前平均渗漏面积为1005.69±105.47μm,治疗后1,3mo后平均875.54±103.27,423.37±79.68μm,与治疗前比较差异有统计学意义(P<0.01),视网膜黄斑中央厚度27例27眼治疗前平均厚度为485.58±122.59μm,治疗后1,3mo后平均398.84±105.32,297.74±89.18μm,与治疗前比较差异有统计学意义(P<0.01)。
　　结论：PDT 封闭 CNV 后,联合玻璃体内腔内注射ranibizumab,有效阻断新生血管复发,减少PDT再次治疗次数和并发症,可提高治疗效果。     

Retinal pigment epithelium tears after intravitreal injection of ranibizumab for predominantly classic neovascular membranes secondary to age‐related macular degeneration

Acta Ophthalmol. 2010: 88: 736–741

Abstract.

Purpose: Retinal pigment epithelium (RPE) tear is an extremely rare complication in patients with classic neovascular membranes without RPE detachment. We evaluate their incidence and functional outcome following treatment with intravitreal ranibizumab. Methods: Observational study of 72 consecutive patients (74 eyes) treated at Jules Gonin University Eye Hospital, Lausanne, with intravitreal ranibizumab 0.5 mg for classic choroidal neovascularization (CNV) between March 2006 and February 2008. Best‐corrected visual acuity (BCVA), fundus examination and optical coherence tomography were recorded monthly; fluorescein angiography was performed at baseline and repeated at least every 3 months. Results: RPE tears occurred in four (5.4%) eyes temporal to the fovea, after a mean of four injections (range 3–6). Mean baseline BCVA was 0.25 decimal equivalent (logMAR 0.67) and improved despite the RPE tear to 0.6 decimal equivalent (logMAR 0.22). Conclusion: RPE tears following intravitreal ranibizumab injections for classic CNV can occur in about 5% of patients, even in the absence of baseline RPE detachment. Nevertheless, vision may improve provided the fovea is not involved.     

光动力疗法联合玻璃体内注射雷珠单抗治疗湿性年龄相关性黄斑变性后黄斑区中心视野的改变

目的　评价光动力疗法（ｐｈｏｔｏｄｙｎａｍｉｃｔｈｅｒａｐｙ,ＰＤＴ）联合玻璃体内注射雷珠单抗治疗湿性年龄相关性黄斑变性（ａｇｅ-ｒｅｌａｔｅｄｍａｃｕｌａｒｄｅｇｅｎｅｒａｔｉｏｎＡＭＤ）后患者黄斑区中心视野的变化情况。方法　本研究纳入湿性ＡＭＤ患者２６例（２８眼）,每例患者予以１次维替泊芬联合ＰＤＴ后３ｄ再给予玻璃体内注射雷珠单抗治疗,然后根据患者治疗后１个月、３个月、６个月的最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、Ｈｕｍｐｈｒｅｙ１０-２中心视野检查、黄斑中心凹厚度（ｃｅｎｔｒａｌｆｏｖｅａｌｔｈｉｃｋｎｅｓｓ,ＣＦＴ）、眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）及吲哚青绿血管造影（ｉｎｄｏｃｙａｎｉｎｅｇｒｅｅｎａｎｇｉｏｇｒａｐｈｙ,ＩＣＧＡ）的渗漏情况决定是否需要再次玻璃体内注射雷珠单抗。结果　联合治疗后１个月、３个月、６个月,湿性ＡＭＤ患者的ＢＣＶＡ明显提高,分别为０．２２±０．０７、０．２６±０．０７、０．２４±０．０８（Ｐ＝０．０２９、０．００４、０．０１５）,而治疗前ＢＣＶＡ为０．１２±０．０９;ＣＦＴ显著降低,分别为（２６４．０９±２８．４０）μｍ、（２７３．４５±２４．８９）μｍ、（２８６．５４±２６．３９）μｍ（均为Ｐ＝０．０００）,而治疗前ＣＦＴ为（４５８．２７±２７．３８）μｍ;中心视野１０°范围内的平均敏感度（ｍｅａｎｓｅｎｓｉｔｉｖｉｔｙ,ＭＳ）增加了,分别为（２４．３３±３．２０）ｄＢ、（２４．５４±３．２５）ｄＢ、（２６．８９±３．４６）ｄＢ（Ｐ＝０．０１５、０．０１０、０．０００）,而治疗前的ＭＳ为（２０．２５±３．１２）ｄＢ;４°范围内ＭＳ增加了,分别为（２３．６６±４．２３）ｄＢ、（２３．４０±４．４９）ｄＢ、（２５．９３±４．４３）ｄＢ（Ｐ＝０．０２４、０．０３４、０．００１）,而治疗前４°范围内ＭＳ是（１９．４９±４．６６）ｄＢ;视野平均缺损（ｍｅａｎｄｅｖｉａ-ｔｉｏｎ,ＭＤ）降低了,分别为（－７．６０±３．２４）ｄＢ、（－７．７２±３．５１）ｄＢ、（－６．２９±３．２１）ｄＢ（Ｐ＝０．００８、０．０１０、０．００１）,而治疗前ＭＤ为（－１１．９８±３．１８）ｄＢ。模式标准差增加了,分别是５．４４±１．５３、５．７８±１．８２、６．８８±１．６５（Ｐ＝０．０１３、０．００４、０．０００）,而治疗前模式标准差为３．３４±１．０４。所有的数据均提示黄斑区的功能有好转。此外,ＢＣＶＡ和ＣＦＴ（ｒ＝－０．２９７,Ｐ＝０．００５）、ＣＦＴ和中心视野１０°范围内的ＭＳ（ｒ＝－０．３８５,Ｐ＝０．０００）、ＣＦＴ和视野的ＭＤ（ｒ＝－０．１９３,Ｐ＝０．０３３）两两之间存在一定的负相关关系。结论　黄斑区中心Ｈｕｍｐｈｒｅｙ视野指数的改变可用于评估ＰＤＴ联合玻璃体内注射雷珠单抗治疗湿性ＡＭＤ后患者视功能的改变。     

干性年龄相关性黄斑变性患者视网膜色素上皮细胞损伤机制

年龄相关性黄斑变性(age-related macular degeneration,AMD)是中老年人视力障碍的重要原因之一。AMD分为2型:萎缩型(干性)和渗出型(湿性)。本文从光照损伤、脂褐素积累、氧化损伤、内质网应激4个方面,综述了干性AMD研究中基于视网膜色素上皮细胞损伤的相关研究进展,为进一步探索其发病机制提供依据和方向。     

AMD并发视网膜色素上皮脱离的研究现状及治疗进展

视网膜色素上皮脱离伴随许多脉络膜视网膜病的疾病进程,尤其常见于AMD.了解AMD并发视网膜色素上皮脱离的发病机制以及脱离类型,不仅有助于预测疾病进程,更可以帮助医生选择合适的治疗方案,改善患者预后.     

雷珠单抗治疗湿性年龄相关性黄斑变性的治疗方案

玻璃体内注射抗血管内皮生长因子药物雷珠单抗（ranibizumab）治疗湿性年龄相关性黄斑变性（AMD）的有效性及安全性已得到多项临床研究证实.目前的研究主要集中在治疗方案的设计与优化方面.从早期的固定治疗模式、按需治疗模式、到近期的稳定性治疗模式和间期延长治疗模式等,治疗方案经历了从仅以视功能为标准到综合考虑视力、疾病活动性、患者依从性和整体医疗耗费等因素的变化,并仍处于不断地改进中.本文回顾了近年来有关雷珠单抗的大规模临床试验结果及相关数据分析,综述了其治疗湿性AMD的治疗方案的研究进展.     

Intravitreal aflibercept in neovascular age-related macular degeneration previously treated with ranibizumab

AIM: To report the change in visual acuity and central macular thickness (CMT) following treatment with intravitreal aflibercept injections in patients with neovascular age-related macular degeneration (nAMD) with suboptimum response to ranibizumab. METHODS: This was a retrospective study. The inclusion criteria were patients with nAMD who responded poorly to ranibizumab. Patients then received either 3 consecutive aflibercept injections followed by PRN treatment or PRN alone. Primary endpoints were mean change in best-corrected visual acuity (BCVA) and CMT at 12mo. Secondary endpoints were number of injections and adverse events. RESULTS: Forty-nine eyes from 49 patients met the inclusion criteria and completed 12-month follow up on aflibercept. Thirty-eight eyes received 3 consecutive aflibercept injections followed by PRN treatment and 11 eyes received pro re nata (PRN) injections alone. At 12mo, mean BCVA improved by one letters (logMAR 0.56±0.31 to 0.54±0.34) and mean CMT decreased from 303.9±82.1 to 259.2±108.3 µm. Four percent of eyes gained 15 letters or more, 6% lost more than 15 letters and the remaining 90% had stable BCVA. The mean number of aflibercept injections was 6. There was one case of infectious endophthalmitis. CONCLUSION: Intravitreal aflibercept in patients with nAMD with a previous suboptimal response to ranibizumab resulted in an anatomical improvement in macular appearance at 12mo without a corresponding improvement in visual acuity.     

Retinal pigment epithelial detachment

Detachment of the retinal pigment epithelium is a prominent feature of many chorio-retinal disease processes, the most prevalent of which is age-related macular degeneration (AMD). Detachment of the retinal pigment epithelium may or may not be associated with choroidal neovascularization and may be caused by different types of pathogenesis, each associated with distinct angiographic features, natural course, visual prognosis, and response to treatment. The phrase "detachment of the retinal pigment epithelium" is used quite often, not always in the correct association and with no clear differentiation between its various types. It is important to identify the specific nature of detachment of the retinal pigment epithelium, and to establish an accurate diagnosis and treatment plan. Therefore, we present a review of the existing types of detachment of the retinal pigment epithelium with what we propose as being appropriate nomenclature and classification, and potential treatment recommendations.     

Bevacizumab versus ranibizumab for neovascular age-related macular degeneration:a Meta-analysis

AIM: To systematically compare the efficacy and safety of off-label bevacizumab versus licensed ranibizumab intravitreal injections as well as monthly regimen versus pro re nata [PRN (as needed)] regimen in the treatment of neovascular age-related macular degeneration (nAMD). METHODS: Relevant publications were identified through automatically retrieve of database and manually retrieving. The methodological quality of studies included was assessed using the Jadad score and the risk-of-bias assessment. The efficacy estimates were measured by the weight mean difference (WMD) for the improvement of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) reduction. The safety estimates were measured by odds ratios (OR) for adverse events rates. Statistical analysis was conducted by Revman 5.2.7. RESULTS: Seven studies were included in the Meta-analysis. There were no statistically significant differences between bevacizumab and ranibizumab in BCVA at 1 and 2y (P=0.37, P=0.18, respectively), However, both drugs has better BCVA given monthly than given as needed at 1 and 2y (P<0.05). The results demonstrated the mean decrease in CRT was less in bevacizumab group than ranibizumab group at 1y (P<0.05), while the difference was not significant at 2y (P=0.24). Treatment monthly gained much more decrease in CRT at 1 and 2y (P<0.005). There were no differences between drugs in the rates of death, arterial thrombotic events and venous thrombotic events (P=0.41, P=0.55, P=0.10, respectively), while the rates of medical dictionary for regulatory activities (MedDAR) system organ class events and ≥1 systemic serious adverse events were higher in bevacizumab group than ranibizumab group (P<0.05). But the incidences of death, arterial thrombotic events, venous thrombotic events, MedDAR system organ class events as well as ≥1 systemic serious adverse events were not statistically different between both treatment regimens of monthly and as needed (P=0.14, P=0.76, P=0.73, P=0.12, P=0.11, respectively). CONCLUSION: Bevacizumab was equivalent to ranibizumab for BCVA, however bevacizumab tended to gain less decrease in CRT and had higher rates of serious adverse events. Compared with treatment as needed, treatment monthly showed superior efficacy in BCVA improvement and CRT reduction, while the rates of adverse events were similar in the two dosing regimens.     

玻璃体注射雷珠单抗治疗老年性黄斑变性黄斑水肿与视网膜静脉阻塞性黄斑水肿的短期疗效观察

目的 观察玻璃体注射雷珠单抗治疗老年黄斑变性黄斑水肿（AMD-ME）与视网膜静脉阻塞性黄斑水肿（RVO-ME）的短期临床效果。设计 回顾性病例系列。研究对象 2015年10月至2016年7月确诊为AMD-ME 及RVO-ME 的患者共30例（30眼）,各15例（15眼）。方法 患眼接受玻璃体注射雷珠单抗（0.5 mg/0.05 ml）治疗,采用1+PRN的注射方法,比较治疗前和治疗后 1 天、1个月最佳矫正视力（BCVA）、眼压（IOP）、黄斑中心凹视网膜厚度（CMT）、注射后消除的水肿高度,评价每次随访时检查结果。主要指标 BCVA、CMT、消除的水肿高度、IOP。结果 AMD-ME组及RVO-ME 组注射雷珠单抗后1天、1个月的BCVA均较术前提高（P=0.000、0.000）。AMD-ME组 及RVO-ME 组每次治疗前和治疗后1个月CMT厚度均降低（P＝0.000、0.000）。治疗过程中患者眼压与治疗前比较并无明显变化 （P=0.096、0.066、0.213、0.088、0.240、0.337）。结论 玻璃体注射雷珠单抗治疗 AMD-ME 及 RVO-ME 在短期内均可减轻黄斑水肿和改善视力,两者治疗效果无明显差异。（眼科, 2017, 26： 120-124）     

Retinal pigment epithelial tears after intravitreal bevacizumab injection for exudative age-related macular degeneration

Purpose: To determine the incidence of and the risk factors for the development of retinal pigment epithelial (RPE) tears after intravitreal bevacizumab (Avastin) injection for the treatment of exudative age‐related macular degeneration (AMD). Methods: A retrospective, multicentre, consecutive interventional case series of all patients with subfoveal exudative AMD treated with intravitreal bevacizumab between August 2005 and April 2007. The main outcome measures were pre‐ and post‐RPE tear visual acuity and choroidal neovascular membrane lesion types, incidence of tears and time from first injection until development of the tear. Results: A total of 920 eyes with exudative AMD were treated with intravitreal bevacizumab. Fifteen eyes from 15 patients developed a RPE tear for an incidence of 1.6%. The average patient age was 79 years. Fourteen of the fifteen eyes (93%) had an occult subfoveal choroidal neovascular membrane. Forty‐seven per cent (7/15) of the RPE tears occurred within the first 6 weeks of treatment, and all tears occurred within the first 18 weeks of treatment initiation. The mean pre‐injection visual acuity was 20/100 with a mean post‐tear visual acuity of 20/200. In all 10 eyes in which the tear involved the fovea, the final visual acuity was poor. Six of the 15 eyes continued with bevacizumab/ranibizumab (Lucentis) injections after tear development, and four of these six eyes continued to have visual improvement. Conclusion: RPE tears occur after intravitreal bevacizumab injections for exudative AMD in approximately 1.6% of eyes and can cause severe vision loss. Maintenance of therapy may help preserve vision after RPE tear development.     

Change of retinal pigment epithelial atrophy after anti-vascular endothelial growth factor treatment in exudative age-related macular degeneration

Purpose:The study aimed to investigate the quantitative changes of retinal pigment epithelial (RPE) atrophy during a 24-month follow-up period of anti-vascular endothelial growth factor (VEGF) for exudative age-related macular degeneration (AMD).Results:The mean number of anti-VEGF treatments was 9.18. RPE atrophic area was 1.293 ± 1.298 mm² at baseline and enlarged to 2.394 ± 1.940 mm² after 24 months, which differed significantly (P = 0.001). Multiple regression analysis revealed that larger areas of RPE atrophy at month 4 and larger numbers of anti-VEGF treatments were associated with increased RPE atrophic areas.Conclusions:RPE atrophy progresses in eyes with exudative AMD during anti-VEGF treatment. Larger areas of RPE atrophy at month 4 and larger numbers of anti-VEGF injections were associated with an increased risk of progression of RPE atrophy the following treatment. These findings may be useful to clinicians using intravitreal anti-VEGF for the treatment of exudative AMD, both for selecting an appropriate treatment plan and for predicting the progression of RPE atrophy.     

Comparison of bevacizumab and ranibizumab in age-related macular degeneration:a systematic review and meta-analysis

AIM: To compare the effectiveness and safety between bevacizumab and ranibizumab in the treatment of age-related macular degeneration (AMD) through a systematic review and meta-analysis.METHODS:We performed a comprehensive search of randomized controlled trials (RCTs), non-RCTs, case-control and cohort studies that compared bevacizumab and ranibizumab using PubMed and the Cochrane Library. After the related data were extracted by two investigators independently, pooled weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects or a fixed-effects model.RESULTS:A total of four RCTs involving 1927 patients and eleven retrospective case series involving 2296 patients were included. For the primary outcomes, no significant differences were found between ranibizumab group and bevacizumab group in visual acuity (WMD:-0.04; 95%CI:-0.08 to 0.00; P=0.06), best corrected visual acuity (WMD:-0.05; 95%CI:-0.10 to 0.00; P=0.05), retina thickness (WMD:-4.69; 95%CI:-13.15 to 3.76; P=0.86) and foveal thickness (WMD:10.91; 95%CI:-14.73 to 36.56; P=0.40). The pooled analyses in the evaluation of safety showed that compared to bevacizumab, ranibizumab was associated with decreased risks of ocular inflammation (RR:0.45; 95% CI:0.23 to 0.89; P=0.02) and venous thrombotic events (RR:0.27; 95%CI:0.08 to 0.89; P=0.03). However, there were no significant differences observed in deaths (P=0.69) and arterial thromboembolic events (P=0.71) between the two groups.CONCLUSION:With equal clinical efficacy, ranibizumab was found to be associated with less adverse events compared to bevacizumab, indicating that ranibizumab might be a safer management.     

miRNA-146a在视网膜色素上皮细胞老化及老年性黄斑变性中的功能研究

目的 检测miRNA-146a(miR-146a)在视网膜色素上皮细胞(retinal pigment epithelial cells,RPE)衰老及老年性黄斑变性(age-related macular degeneration,AMD)中的表达水平,并探讨其通过抑制VEGF-A表达,参与调控AMD病变进程的机制.方法 qRT-PCR检测年龄为2个月、8个月、12个月、18个月和24个月小鼠的RPE及75岁晚期“湿”性AMD患者眼球中miR-146以及VEGF-A的mRNA表达水平.Western Blotting检测VEGF-A蛋白表达水平.在ARPE-19细胞系中转染miR-146a,通过qRT-PCR及Western Blotting检测miR-146a对VEGF-A mRNA及蛋白水平的影响.结果 在自然衰老的RPE中,miR-146的表达呈现随年龄增加逐渐上升的趋势,与2个月的小鼠相比,在18个月及24个月的小鼠中miR-146a水平上升约8倍及24倍.而VEGF-A的表达呈现下降趋势,与对照相比,24个月的小鼠RPE中的VEGF-A相对水平由2个月时的1.5倍降为0.8倍.但是在AMD患者中,病灶部位的miR-146a较病灶旁侧表达下降14.5倍,VEGF-A表达上升.在ARPE-19细胞中过表达miR-146a抑制了VEGF-A的mRNA及蛋白表达水平.结论 本实验结果将miR-146a与RPE衰老及AMD的发生联系在一起,未来有可能成为RPE衰老及AMD早期诊断的新的分子标记物,为制定临床治疗策略提供参考.