玻璃体腔内注射Bevacizumab治疗年龄相关性黄斑变性视野改变

目的 观察玻璃体腔内注射Bevacizumab(Avastin)治疗湿性年龄相关性黄斑变性(ARMD)术后各时间段的视野变化情况.方法 采用单中心随机临床研究方法.收集经间接眼底镜、荧光素眼底血管造影(FFA)以及光学相干断层扫描(OCT)检查确诊存在黄斑中心凹下脉络膜新生血管(CNV)的ARMD患者13例(15只眼),患眼最佳矫正视力均>0.1.患眼行Bevacizumab玻璃体腔内注射1.25mg(0.05ml),注射次数为6次,间隔6周至3个月,治疗后随访3～12个月,记录并分析术前及术后6周,3月,6月,12月的平均视觉敏感度(mean visual sensitivity,MS),平均缺损(mean defect,MD),缺损变异度(lose variance,Lv)的变化.结果 以0周注射为基准,第24周及48周MS值与注射前MS值相比有显著性差异(t值分别为2.91、3.69,P值均<0.05));第48周MD值与注射前MD值(7.97±3.97)dB差异有统计学意义(t值为1.35,P<0.05);各组LV值与注射前LV值比较差异无统计学意义.结论 多次玻璃体腔内注射Bevacizumab有利于改善湿性ARMD患者黄斑区视功能,主要体现在对视网膜平均敏感度以及平均缺损的改善上;重复4-6次注射后绝大多数湿性ARMD患者的视功能得到改善.     

玻璃体腔内注射Bevacizumab治疗年龄相关性黄斑变性视野改变

目的 观察玻璃体腔内注射Bevacizumab(Avastin)治疗湿性年龄相关性黄斑变性(ARMD)术后各时间段的视野变化情况.方法 采用单中心随机临床研究方法.收集经间接眼底镜、荧光素眼底血管造影(FFA)以及光学相干断层扫描(OCT)检查确诊存在黄斑中心凹下脉络膜新生血管(CNV)的ARMD患者13例(15只眼),患眼最佳矫正视力均>0.1.患眼行Bevacizumab玻璃体腔内注射1.25mg(0.05ml),注射次数为6次,间隔6周至3个月,治疗后随访3～12个月,记录并分析术前及术后6周,3月,6月,12月的平均视觉敏感度(mean visual sensitivity,MS),平均缺损(mean defect,MD),缺损变异度(lose variance,Lv)的变化.结果 以0周注射为基准,第24周及48周MS值与注射前MS值相比有显著性差异(t值分别为2.91、3.69,P值均<0.05));第48周MD值与注射前MD值(7.97±3.97)dB差异有统计学意义(t值为1.35,P<0.05);各组LV值与注射前LV值比较差异无统计学意义.结论 多次玻璃体腔内注射Bevacizumab有利于改善湿性ARMD患者黄斑区视功能,主要体现在对视网膜平均敏感度以及平均缺损的改善上;重复4-6次注射后绝大多数湿性ARMD患者的视功能得到改善.     

玻璃体腔注射Bevacizumab(Avastin)治疗湿性ARMD临床观察

目的:观察玻璃体腔注射bevacizumab(avastin)治疗湿性年龄相关性黄斑变性(age-related macular degeneration,ARMD)的疗效和安全性。方法:对22例22眼湿性ARMD患者行玻璃体腔注射bevacizumab1.25mg,间隔6wk再注射1次,第12wk对检查发现黄斑区水肿或渗漏明显的再注射1次。随访6mo,术后第1wk;1,3,6mo行视力、眼压、裂隙灯、间接检眼镜及光学相干断层扫描(optical coherence tomography,OCT)检查,第3,6mo行荧光素眼底血管造影(fundusfluorescence angiography,FFA)、彩色眼底照相检查,分析治疗前后患者平均视力及黄斑中心视网膜厚度(centralmacular thickness,CMT)的改变。结果:至第6mo随访,平均视力较治疗前有所提高,平均CMT比治疗前减少92.59μm,均有显著意义;FFA显示黄斑区渗漏均消失或明显减轻。除4例局部球结膜下出血,没有观察到其他不良反应。结论:玻璃体腔注射bevacizumab能够提高湿性ARMD患者的视力,减轻黄斑水肿;重复注射可以巩固疗效,减少复发。长期效果和安全性还需要更多病例和更长随访观察时间来评估。     

玻璃体腔内注射Bevacizumab治疗视网膜新生血管性眼压改变

目的 初步探讨玻璃体腔内注射Bevacizumab治疗视网膜新生血管性疾病术后早期眼压变化.方法 对13例(18眼)视网膜新生血管性疾病,其中年龄相关性黄斑变性(10例,12眼)、糖尿病视网膜病变(3例,6眼),所有患者分别在第0周,6周,12周行玻璃体腔内注射Bevacizumab 1.25mg.在注射前后5min,30min,1h,2h进行眼压检查.结果 以0周注射为例,5min,30min,1h,2h内眼压分别为(18.7±5.4)mmHg、(18.1±5.3)mmHg、(17.3±5.4)mmHg,与注射前平均眼压(14.6±4.1)mmHg相比差异有统计学意义(t值分别为2.81、3.45、2.63,P值均<0.05).而随访的2h平均眼压降为(15.6±5.8)mmHg,与注射前相比差异无统计学意义(t=0.15,P>0.5).在总共48次注射中,注射后眼压监测5min时IOP值高于正常眼压值(IOP>21mmHg)的百分率为41.7%,30min时高于正常眼压值的百分率为22.9%,而在1h内85.4%,2h内91.7%的眼压测量值恢复正常.结论 玻璃体腔内注射Bevacizumab治疗视网膜新生血管性疾病早期眼压(5min)呈现短暂升高后下降,术后2h可作为门诊玻璃体腔内注射Bevacizumab早期眼压监测时间点.     

玻璃体腔注射Bevacizumab治疗糖尿病黄斑水肿的疗效观察

目的观察玻璃体腔注射Bevacizumab治疗糖尿病黄斑水肿的临床疗效。方法 65例(66眼)糖尿病黄斑水肿患者初始均行玻璃体腔注射Bevacizumab治疗,观察患眼治疗前、后最佳矫正视力、黄斑水肿分级、黄斑水肿渗漏类型及黄斑中心视网膜厚度和黄斑总体积的变化情况。对其中前3个月内仅接受单次玻璃体腔注射Bevacizumab治疗的38例(41眼)患者治疗前、治疗后2周、6周和12周的各项指标进一步进行统计分析。结果 65例(66眼)DME患者治疗前平均最佳矫正视力字母数、平均黄斑中心视网膜厚度和黄斑总体积分别为39.81±17.18、(514.11±247.43)μm和(11.70±2.37)mm3,末次随访时分别为43.45±14.38、(455.47±193.34)μm和(10.64±2.13)mm3。其中前3个月内进行单次玻璃体腔注射Bevacizumab治疗的38例(41眼)患者治疗前平均最佳矫正视力字母数为45.09±12.68,治疗后2周、6周和12周时分别为52.45±13.67、59.09±12.31和50.36±11.72,治疗后视力明显提高,与治疗前相比差异均有统计学意义(均为P<0.05);平均黄斑中心视网膜厚度治疗前为(503.95±246.79)μm,治疗后2周、6周和12周分别为(348.91±209.76)μm、(327.93±127.60)μm和(444.00±193.61)μm,治疗后厚度明显变薄,与治疗前相比差异均有统计学意义(均为P<0.05);治疗前黄斑总体积为(11.07±2.23)mm3,治疗后2周、6周和12周时分别为(10.25±1.81)mm3、(9.76±2.01)mm3和(9.92±1.49)mm3,治疗后体积缩小,与治疗前相比差异均无统计学意义(均为P>0.05)。所有患者随访期间均未见明显严重不良事件发生。结论玻璃体腔注射Bev-acizumab可减轻糖尿病黄斑水肿患者视网膜水肿程度,提高患眼视力,但疗效持续时间有限,单次注射疗效约可维持8~12周。其长期有效性和安全性仍有待多中心临床试验验证。     

抗血管内皮生长因子药物玻璃体腔注射以及联合光动力疗法治疗渗出型老年性黄斑变性疗效观察

目的 观察抗血管内皮生长因子(VEGF)药物ranibizumzb玻璃体腔注射与光动力疗法(PDT)联合ranibizumzb玻璃体腔注射治疗渗出型老年性黄斑变性(AMD)的疗效.方法 渗出型AMD患者30例30只眼,分为ranibizumzb玻璃体腔注射治疗组与PDT联合ranibizumzb玻璃体腔注射治疗组,每组各15例15只眼.治疗及随访时间6～17个月,平均治疗随访时间12.5个月.其中,ranibizumzb玻璃体腔注射治疗组玻璃体腔注射ranibizumzb 0.5 mg,每一个月1次,连续注射12个月;自第一次治疗后每一个月随访1次.PDT联合ranibizumzb玻璃体腔注射治疗组于PDT后24 h内玻璃体腔注射相同剂量ranibizumzb,第2、3个月分别再行相同剂量ranibizumzb玻璃体腔注射;于3次治疗后每一个月随访1次,随访期内出现重复治疗指征则重复注射1次.Ranibizumzb玻璃体腔注射平均次数(3.7±1.O)次.对比观察两组患者治疗前后最佳矫正视力( BCVA)、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)和MP-1微视野计检查结果、ranibizumzb玻璃体腔注射平均次数及并发症.结果 治疗后第1、3、6、12个月,ranibizumzb玻璃体腔注射治疗组患眼黄斑区平均光敏感度(MS)平均提高值分别为1.9、3.8、5.0、5.5 dB,PDT联合ranibizumzb玻璃体腔注射治疗组患眼MS平均提高值为2.0、4.2、3.7、4.8 dB.两组MS提高值比较,差异无统计学意义(t=-0.791、-0.171、1.339、0.785;P=0.943、0.865、0.173、0.898).BCVA、OCT改变情况比较,差异无统计学意义(P＞0.05).MS与BCVA之间为正相关(r=0.660,P=0.037).随访期间未发现眼内感染、视网膜色素上皮撕裂和玻璃体积血等并发症.结论 Ranibizumzb玻璃体腔注射与PDT联合ranibizumzb玻璃体腔注射均为治疗渗出型AMD的有效方法,但后者能有效减少ranibizumzb玻璃体腔重复注射的次数.     

玻璃体腔注射康柏西普治疗湿性年龄相关性黄斑变性的早期mfERG变化

目的：利用多焦视网膜电图(mfERG)评价玻璃体腔注射康柏西普的湿性年龄相关性黄斑变性(age-related macular degeneration,ARMD)患者视网膜功能的早期变化。

方法：经眼底荧光血管造影确诊为湿性ARMD患者接受玻璃体腔注射康柏西普眼用注射液(0.05mL/0.5mg),记录注射前及注射后1mo的最佳矫正视力及mfERG各环N1、P1波潜伏期及P1波振幅密度。

结果：共20例20眼患者纳入研究,平均LogMAR视力从注射前0.80±0.48提高到注射后0.65±0.50(P<0.001),环1平均振幅密度从注射前39.59±16.60nV/deg²提高到注射后的53.81±20.41nV/deg²(P=0.006),振幅密度的改变与视力的改变呈正相关(r=-0.776,P<0.001)。

结论：对于湿性ARMD患者玻璃体腔注射康柏西普短期内能改善黄斑中心凹的功能。     

黄斑程序蓝/黄视野检查评估糖尿病性黄斑囊样水肿视功能的研究

目的 探讨黄斑程序蓝/黄视野检查在糖尿病性黄斑囊样水肿(cystoid macular edema,CME)诊断、预后判断及视功能评估中的作用.方法 收集糖尿病视网膜病变(diabetic retinopathy,DR)发生CME患者28例(28眼)(CME组),无CME患者24例(24眼)(NCME组),采用瑞士Octopus101型全自动视野计黄斑程序分别进行白/白视野(white-on-white perimetry,W/WP)和蓝/黄视野(blue-on-yellow perimetry,B/YP)检查,记录视野平均光敏感度(mean sensitivity,MS)值、平均缺损(mean defcct,MD)值等指标.结果 在W/WP检查中,NCME组MS值(26.23±2.71)dB显著大于CME组MS值(23.91±3.37)dB,差异有显著统计学意义(P＜0.01);NCME组MD值(1.99±1.27)dB显著小于CME组MD值(4.33±1.92)dB,差异也有显著统计学意义(P＜0.01).在B/YP检查中,NCME组MS值(20.08±2.16)dB显著大于CME组MS值(15.13±2.24) dB,差异有显著统计学意义(P＜0.01);NCME组MD值(6.63±2.30)dB显著小于CME组MD值(11.59±3.46)dB,差异有显著统计学意义(P＜0.01).W/WP检查MS(r=-0.357,P=0.009)、MD(r=-0.584,P＜0.01),与DR患者有无CME显著相关;B/YP检查MS(r=-0.753,P＜0.01)、MD(r=-0.645,P ＜0.01),也与DR患者有无CME显著相关.结论 视野检查尤其是黄斑程序B/YP是糖尿病性CME临床诊断、视功能评估的方法之一,可以作为DR常规检查项目,有利于CME的早期发现及疗效观察.     

玻璃体腔注射bevacizumab治疗年龄相关性黄斑变性的初步临床观察

目的初步探讨玻璃体腔内注射bevacizumab（Avastin）治疗湿性年龄相关性黄斑变性（ARMD）的临床效果。方法采用单中心非随机对照临床研究方法。收集经荧光素眼底血管造影检查（FFA）、相干光断层成像术（OCT）确诊存在黄斑中心凹下脉络膜新生血管（CNV）的ARMD患者5例,患眼最佳矫正视力均〈0．1,无全身和局部手术禁忌证。患眼行bevacizumab玻璃体腔内注射术,用量为1．5mg（0．06ml）,记录手术前、后患眼的视力、眼压、FFA和OCT的检查结果。术后随访时间4～6个月。结果全部患者均未出现眼内和全身不良反应。1例患者术后第3天出现一过性眼压升高,局部给予降眼压药物治疗后症状得到控制。1例患者术后1周视力由0．1上升至0．4;4例患者术后2个月视力提高1—6行,其中3例于术后4—6个月时视力保持稳定,1例视力下降。3例患者术后1个月黄斑水肿明显改善,黄斑中心凹视网膜厚度较术前减少5．9％～41．4％,3例患者FFA显示CNV渗漏较术前减轻。结论玻璃体腔内注射bevacizumab治疗湿性ARMD安全,副作用少,可改善患者的视功能,减轻黄斑水肿,减少CNV渗漏,有望成为药物治疗ARMD的新方法,但尚需进行多中心大样本临床随机对照研究。     

经瞳孔温热疗法治疗中心性浆液性脉络膜视网膜病变的疗效观察

目的 观察经瞳孔温热疗法(transpupillary thermotherapy,TTT)治疗中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的疗效和安全性.方法 33例35眼CSC患者作为治疗组进行TTT治疗,12例12眼作为对照组行药物治疗,分别于治疗前及治疗后1个月、3个月进行视力、眼底、光学相干断层扫描、眼底荧光血管造影术、视野等检查,用SPSS 11.5统计软件分析视力、黄斑中心凹体积、神经上皮层和(或)色素上皮层下渗液高度、中心视野G2程序中平均光敏感度(mean defect,MS)值、平均缺损(mean defect,MD)值,以观察并对照2组的疗效和安全性.结果 治疗后1个月,TTT组视力提高18眼,药物治疗组视力提高3眼;治疗后3个月,TTT组视力提高22眼,药物治疗组视力提高6眼.治疗后1个月,TTT组黄斑体积及渗液高度与治疗前相比差异有统计学意义(P＜0.05),而药物治疗组与治疗前差异无统计学意义(P＞0.05).治疗后3个月,TTT组MS、MD值与治疗前相比差异均有统计学意义(P＜0.05),药物治疗组MS值与治疗前相比差异有统计学意义(P＜0.05),MD值与治疗前相比差异无统计学意义(P＞0.05).结论 TTT治疗CSC确实有效且安全,与单纯药物治疗相比,能缩短病程,有助于保护黄斑功能.     

Inferior limited macular translocation for subfoveal choroidal neovascularization secondary to age-related macular degeneration: 1-year visual outcome and recurrence report

PURPOSE: To report the 1-year visual outcomes and incidence of persistent and recurrent choroidal neovascularization (CNV) after limited macular translocation (LMT) for subfoveal CNV in patients with age-related macular degeneration (ARMD). DESIGN: Interventional case series. METHODS: Retrospective review of 102 consecutive eyes of 101 patients that had the inferior limited macular translocation procedure for subfoveal choroidal neovascularization secondary to ARMD. The outcome measures were visual acuity at 12 months after surgery, change in visual acuity from baseline, the proportion of eyes with moderate (3 or more lines) or severe (6 or more lines) visual acuity loss, and cumulative incidence of persistent or recurrent CNV and its impact on visual acuity. Cumulative incidence was estimated using Kaplan-Meier survival analysis methods. Association between persistence and recurrence of CNV and the Snellen visual acuity recorded at each follow-up visit was evaluated using the Wilcoxon rank-sum test. RESULTS: Eighty-six (84.3%) of 102 eyes completed the 1-year follow-up. By 12 months postoperatively, 35 (40.7%) of the 86 eyes achieved visual acuity of 20/100 or better while 34 (39.5%) of the 86 eyes experienced 2 or more Snellen lines of visual improvement. In the 52 eyes with effective translocation and complete laser photocoagulation of the CNV complex with sparing of the sensory fovea, the estimated incidence of recurrence was 34.6% at 12 months (95% confidence interval of 21%-48%). Sixty-five percent of the recurrences were subfoveal and caused a decrease in visual acuity. There was a trend toward worse median change in visual acuity in eyes with persistent or recurrent CNV. CONCLUSIONS: Limited macular translocation for the treatment of subfoveal CNV secondary to ARMD is associated with improvement in visual acuity in approximately 39.5% of eyes and enables complete laser photocoagulation of the neovascular complex with sparing of the sensory macula in approximately 60.4% of eyes that complete 1 year follow-up. Persistence and recurrence of CNV are common after LMT and are important causes of vision loss. Further studies are warranted to more precisely evaluate the risks and benefits of LMT in ARMD.     

贝伐单抗治疗老年性黄斑变性临床观察

目的：评价玻璃体腔内注射贝伐单抗（阿瓦斯汀）治疗老年性黄斑变性（age-related macular degeneration,AMD）的临床效果与安全性。方法：对48例50眼接受玻璃体腔注射bevacizumab（1.75mg）治疗的AMD患者进行回顾分析,通过常规眼科检查方法、光学相干断层扫描（OCT）、眼底荧光血管造影（FFA）和/或吲哚青绿血管造影（ICGA）等方法,观察治疗后1,3,7d; 1,6mo 最佳矫正视力（best corrected visual acuity,BCVA）、眼压、晶状体、玻璃体、黄斑中心凹厚度（central foveal thickness,CFT）和黄斑容积（total macular volume,TMV）变化,与治疗前对比分析。对注射后渗漏无明显改善或病情反复者进行眼内重复注射,所有病例都完成至少3mo的观察随访。玻璃体腔内注射avastin 1.75mg,每6wk注射一次。结果：在48例50眼患者中,平均年龄58±20.46岁。治疗前患者的基线平均对数BCVA为0.82±0.53,CFT为364.97±151.83μm,注药后1wk虽然平均CFT和TMV没有显著改善,但BCVA有显著提高,经平均9.7mo的随访,BCVA,CFT和TMV3项指标均较基线有显著改善,终末随访时BCVA提高至少两行者为32眼（64%）,稳定者为18眼（36%）。本组患者共接受了98次玻璃体腔内注射,平均注射次数为1.98次/眼,有50%患者再注射能在术后1wk使视力提高两行或两行以上。治疗过程中未发现严重不良反应。结论：玻璃体腔内注射bevacizumab治疗湿性AMD引起的CNV安全、副作用少,可改善患者的视功能（VA）,减轻黄斑水肿,减少CNV渗漏。但长期治疗效果需要进一步观察。     

Intravitreal injection of bevacizumab combined with verteporfin photodynamic therapy for choroidal neovascularization in age-related macular degeneration

PURPOSE: To report the outcome for eyes treated with intravitreal injection of bevacizumab combined with verteporfin photodynamic therapy (PDT) for choroidal neovascularization (CNV) in age-related macular degeneration (AMD). STUDY DESIGN AND PARTICIPANTS: Interventional, consecutive, retrospective case series including 40 eyes of 40 patients with newly diagnosed juxtafoveal or subfoveal CNV secondary to AMD. METHODS: The charts of patients treated with a 1.25-mg intravitreal injection of bevacizumab followed by PDT within a 2-week period were reviewed. Main outcome measures were visual acuity stabilization (defined as no change or a gain in visual acuity) and need for retreatment. RESULTS: Thirty-three (83%) of 40 eyes had stabilization of visual acuity. Mean improvement in visual acuity was 1.73 lines. Twenty-six eyes (65%) required only a single intravitreal injection of bevacizumab combined with PDT. Of the 23 eyes with 12 months of follow-up, 17 (74%) had stabilization of visual acuity, while 9 (40%) had improvement in visual acuity (mean, 1.22 Snellen lines). Eleven eyes (48%) required only a single combined treatment for CNV resolution at the 12-month follow-up. Fifteen (88%) of 17 eyes with only 6 months of follow-up required only a single combined treatment. There were no complications such as endophthalmitis, uveitis, or ocular hypertension. CONCLUSION: These findings suggest that eyes treated with both intravitreal injection of bevacizumab and PDT require none to a minimal number of re-treatments to have stabilization of vision, even at 12 months of follow-up. Further investigation with large controlled trials is warranted to outline the appropriate treatment paradigm for combination therapy.     

Standardized visual acuity results associated with primary versus secondary bevacizumab (avastin) treatment for choroidal neovascularization in age-related macular degeneration

PURPOSE: To compare standardized visual outcomes and macular thickness changes associated with primary and secondary bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) therapy for choroidal neovascularization (CNV) in age-related macular degeneration (AMD). METHODS: Eighteen eyes received primary bevacizumab treatment; 20 eyes received pegaptanib (Macugen; Eyetech/OSI Pharmaceuticals, New York, NY) as initial treatment followed by bevacizumab therapy. Both medications were injected at 6-week intervals. Best-corrected visual acuity was measured with the ETDRS chart. Three- and 6-month data were analyzed for all eyes. RESULTS: Mean visual acuity improvement in the primary bevacizumab treatment cohort was 1.5 ETDRS lines at 3 months (P = 0.0009) and 2.2 ETDRS lines at 6 months (P=0.0004) compared with -0.4 ETDRS line at 3 months (P=0.27) and 0.2 ETDRS line at 6 months (P=0.70) in the secondary bevacizumab treatment group. Mean decrease in retinal thickness was also higher in the primary bevacizumab treatment group (90.9 microm [P=0.0037] vs 43.8 microm [P=0.13], respectively) than in the secondary bevacizumab treatment group (73.72 microm [P=0.051] vs 33.0 microm [P=0.21], respectively) at 3 months and 6 months. CONCLUSION: Primary bevacizumab therapy resulted in significantly greater visual improvement than secondary bevacizumab treatment at 3 months or 6 months. To our knowledge, this is the first report comparing primary bevacizumab treatment of CNV in AMD with secondary bevacizumab treatment after multiple pegaptanib injections.     

Short-term safety and efficacy of intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab (Avastin, Genentech Inc.) for the treatment of neovascular age-related macular degeneration (ARMD). METHODS: A retrospective review was performed on consented patients with neovascular ARMD receiving intravitreal bevacizumab therapy. All patients received intravitreal bevacizumab at baseline with additional monthly injections given at the discretion of the treating physician. At each visit, a routine Snellen visual acuity assessment was performed followed by an ophthalmic examination and optical coherence tomography (OCT) imaging. RESULTS: Fifty-three eyes of 50 patients received an intravitreal bevacizumab injection between May and August 2005. Including the month 3 visit, the average number of injections was 2.3 out of a maximum of 4 injections. No serious drug-related ocular or systemic adverse events were identified. Improvements in visual acuity and central retinal thickness measurements were evident by week 1 and continued through month 3. At month 3, the mean visual acuity improved from 20/160 to 20/125 (P < 0.001) and the mean central retinal thickness decreased by 99.6 microm (P < 0.001). CONCLUSION: Off-label intravitreal bevacizumab therapy for neovascular ARMD was well tolerated over 3 months with improvements in visual acuity and OCT central retinal thickness measurements. While the long-term safety and efficacy of intravitreal bevacizumab remain unknown, these short-term results suggest that intravitreal bevacizumab may be the most cost effective therapy for the treatment of neovascular ARMD.     

Preoperative factors influencing visual outcome following surgical excision of subfoveal choroidal

PURPOSE: To evaluate long-term visual acuity outcomes and the influences of various preoperative factors on visual outcome in patients undergoing surgical removal of choroidal neovascular neovascularization (CNV) caused by age-related macular degeneration (ARMD). METHODS: The authors studied 146 eyes of 146 patients who were followed for at least 1 year after surgical excision of CNV associated with ARMD. Surgical indications included subfoveal active CNV localized mainly above the retinal pigment epithelium (RPE) and a standard Japanese decimal visual acuity of 0.3 or worse. CNV above the RPE was diagnosed by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. CNVs were divided into completely classic CNV or mainly classic CNV. The relationships of the post-operative logarithm of the minimum angle of resolution (logMAR) visual acuity with preoperative logMAR visual acuity, the shortest distance from the center of the foveal avascular zone to the CNV margin, CNV size, and age were analyzed. RESULTS: Final logMAR visual acuity was improved (defined as a logMAR visual acuity increase of 0.2 or more) in 78 eyes (54%), stable in 47 (32%), and worsened in 21 (14%). Stepwise regression identified CNV size as a significant factor influencing final logMAR visual acuity (R2 = 0.213, p<0.0001), while preoperative logMAR visual acuity, shortest distance from the center of the foveal avascular zone to the CNV margin, and age showed no significant correlation with final logMAR visual acuity. Surgical complications included retinal detachment in six eyes (4%), subretinal hematoma in four eyes (2%), macular hole in three (2%), and proliferative vitreoretinopathy in two (1%). CNV recurred postoperatively in 18 eyes (12%). In 92 eyes with completely classic CNV, visual acuity was improved in 57 (62%), stable in 27 (29%), and worsened in 8 (9%). In 54 eyes with mainly classic CNV, visual acuity was improved in 21(39%), stable in 20 (37%), and worsened in 13 (24%). CONCLUSIONS: Surgical excision of CNV for ARMD was effective for completely classic CNV, and better postoperative visual acuity was achieved in cases of small CNV. Given the fact that photodynamic therapy (PDT) has only been used in Japan since 2004, future study should compare PDT and surgical excision in Japanese subjects for relative merits against surgical risk and postoperative complications, to define indications for PDT and surgical excision.