An efficacy comparison of combination of different anti-vascular endothelial growth factors and photodynamic therapy in patients with pachychoroid neovasculopathy

Purpose

To evaluate anatomical and visual outcomes in patients who received intravitreal anti-vascular endothelial growth factor (VEGF) agents in combination with full-dose photodynamic therapy (PDT) on eyes with choroidal neovascularization (CNV) secondary to naive pachychoroid neovasculopathy (PNV).

Materials and Methods

Medical records on 19 eyes of 19 patients whom intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), and intravitreal aflibercept (IVA) injections were administered for CNV caused by PNV were enrolled into the study. The central macular thickness (CMT), best-corrected visual acuity (BCVA), and subfoveal choroidal thickness (SFCT) were recorded at the baseline, months 1, 3, 6, 12, and final control visit following treatment.

Results

The age average was 53.84?±?5.23 years (range, 46–62 years), and mean follow-up time was 33.42?±?9.43 months (range, 16–49 months). The change in BCVA was found statistically significant in the IVA group only during follow-up visits (p?=?0.007). Although there was no statistically significant change in CMT following IVR (360.60?±?75.64–252?±?75.04 µm) (p?=?0.077), significant changes were observed in IVB (397.14?±?122.59–275.28?±?63.82 µm) (p?=?0.004) and IVA (385.85?±?43.82–244.42?±?51.57 µm) (p?=?0.005) between the baseline and the final visit. SFCT significantly decreased following both IVR and IVA treatments (p?=?0.016, p?=?0.039, respectively). In consideration of the number of injections, significantly fewer injections were needed in the IVA group than the others (p?=?0.018).

Conclusions

Anti-VEGF agents with full-dose PDT were well tolerated for the first 3 months and were highly effective treatment option in order to naive PNV patients. However, in long-term follow-ups, the effectiveness of IVA was superior to other anti-VEGFs.

     

光动力疗法、抗血管内皮生长因子药物玻璃体腔注射及二者联合治疗晚期渗出型老年性黄斑变性疗效观察

目的 观察光动力疗法(PDT)、抗血管内皮生长因子(VEGF)药物玻璃体腔注射及二者联合治疗晚期渗出型老年性黄斑变性(AMD)的临床效果.方法 临床确诊为晚期渗出型AMD的28例患者32只眼纳入研究.其中,15只眼行PDT或抗VEGF药物单一治疗,17只眼行联合治疗.治疗后随访5～28个月,平均随访时间21个月.治疗后第1、2周以及每一个月行常规视力、眼压和光相干断层扫描(()CT)检查,每3个月行荧光素眼底血管造影( FFA)检查.观察所有患者治疗前后视力、黄斑渗漏及中央视网膜厚度(CRT)的变化及不良反应发生情况.对比分析单一治疗组和联合治疗组平均治疗次数的差异.结果32只眼中,视力提高20只眼,占62.5％;不变9只眼,占28.1％;下降3只眼,占9.4％.黄斑渗漏消失17只眼,占53.1％;减少12只眼,占37.5％;增加3只眼,占9.4％.CRT减少23只眼,占71.8％;增厚9只眼,占28.2％.单一治疗组治疗次数2～7次,平均治疗次数(3.4±0.5)次;联合治疗组治疗次数1～4次,平均治疗次数(2.3±0.2)次.联合治疗组治疗次数明显少于单一治疗组,差异有统计学意义(t=4.005,P＜0.05).所有患者在随访期间均未发生不良反应.结论 PDT、玻璃体腔注射抗VEGF药物及二者联合治疗晚期渗出型AMD均可改善患者病情和视力.联合治疗可减少治疗次数.     

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.     

光动力疗法在抗血管内皮生长因子时代的存在价值

新生血管类眼底疾病是导致患者中心视力严重丧失的常见原因之一.血管内皮生长因子(VEGF)在病理性新生血管的发病过程中起着非常重要的作用.近年来,抗VEGF药物的研发及广泛的临床应用改变了很多新生血管类疾病的预后,使这类疾病的治疗逐步进入了抗VEGF时代,特别是对以脉络膜新生血管(CNV)为主要病理改变的湿性年龄相关性黄斑变性(wAMD)疾病的治疗取得了突破性的进展,改变了既往以光动力疗法(PDT)为主的wAMD治疗模式.虽然PDT在AMD治疗中退居次要地位,但仍然具有存在的意义,对于特殊情况下的AMD和特殊的CNV病灶,以及一些特定疾病的治疗具有重要价值.     

Endophthalmitis associated with intravitreal anti-vascular endothelial growth factor therapy injections in an office setting

PURPOSE: To determine the incidence of endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. DESIGN: A retrospective interventional case series. METHODS: A total of 10,254 intravitreal anti-VEGF injections (406 pegaptanib, 3,501 bevacizumab, and 6,347 ranibizumab) were performed from January 5, 2005 to October 18, 2007. The number of the injections was determined from the injection log books and billing records. The injections were performed as an office based procedure with use of povidone-iodine as a part of preinjection preparation. Preinjection antibiotics, eye drape, or surgical attire were not used. The main outcome measures were the incidence of suspected and proven endophthalmitis. RESULTS: There were three cases of suspected endophthalmitis, one case following bevacizumab injection and two cases following ranibizumab injection. There was no case of culture-proven endophthalmitis. All three patients regained their preinjection visual acuity. The incidence of suspected endophthalmitis was 0.029% (95% confidence interval, 0.006% to 0.085%). There was no difference in the incidence of endophthalmitis between ranibizumab and bevacizumab injections (P = .6). CONCLUSIONS: Although there is no consensus regarding the intravitreal injection procedure technique, the incidence of suspected endophthalmitis was very low in a large series of injected patients in a community setting and the incidence compares favorably with that reported in clinical trials where much more extensive preinjection preparation was mandated. We found no difference in the endophthalmitis risk of patients receiving bevacizumab as compared with ranibizumab.     

孕期玻璃体腔注射抗血管内皮生长因子药物治疗研究现状

玻璃体腔注射抗VEGF药物在治疗眼底血管性疾病方面得到广泛应用并取得良好效果。孕早期是胎儿器官生成、血管发育的重要时期。现已有研究证明了VEGF在维持胎儿和胎盘血管系统中的重要作用,其水平缺失及下降会影响胚胎发育,导致流产。鉴于抗VEGF药物可能会对母亲和胎儿造成系统性副作用,因此关于孕期玻璃体腔注药的安全性仍存在较大争议。通过总结分析现有关于孕期使用玻璃体腔注射抗VEGF药物治疗的23例病例报道,有3例患者经贝伐单抗治疗后流产。提示临床对孕期患者使用抗VEGF药物时应谨慎,并应向患者详细说明眼部副作用和全身副作用的可能性,在决定是否在怀孕期间使用药物时,应该考虑暴露的时间与血管发育关键期的关系以及不同药物的全身暴露情况。目前临床缺乏孕期抗VEGF药物使用情况分析的大样本量研究,其安全性仍有待进一步观察分析。     

Real-world outcomes of combined therapy of photodynamic therapy with anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy

ObjectivesTo describe the real-world outcomes of photodynamic therapy (PDT) as a rescue therapy in eyes with polypoidal choroidal vasculopathy (PCV) refractory to anti-vascular endothelial growth factor (VEGF) monotherapy in a British cohort of patients.MethodsThis is a retrospective chart review of 53 eyes with PCV. Based on the timing of PDT, the eyes were stratified into two groups (9 in the Initial-PDT group, 44 in the Deferred group). The number of anti-VEGF injections/year and the best corrected visual acuity (BCVA) before and after PDT were analysed. Multivariate regression model was created to identify factors predictive of visual outcome and treatment burden after PDT.ResultsThe Deferred group received a mean of 9.4 injections/year but significantly reduced to 7.2 after PDT (p < 0.001). The Initial-PDT group required significantly fewer injections after PDT compared to the Deferred group (p = 0.004). The Deferred group experienced improvement in BCVA from 58.7 letters at baseline to 63.8 at 18-months follow-up (p < 0.001), but no significant increase was observed in the Initial-PDT group (p = 0.310). Better baseline BCVA is associated with higher likelihood of achieving good BCVA ≥ 70 letters after PDT (Odd Ratio=1.12, 95% CI: 1.03–1.21, p = 0.006), while increased number of anti-VEGF injections/year before PDT reduces the likelihood of easing treatment burden to ≥12 weeks apart between each injection after PDT (Odd Ratio=0.724, 95% CI: 0.58–0.91, p = 0.006).ConclusionsPDT as a rescue therapy is beneficial in the long-term management of PCV, particularly in eyes that had experienced a significant period of prior exposure to anti-VEGF monotherapy.Subject terms: Macular degeneration, Drug therapy     

Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization

Purpose

To evaluate the long-term efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy as primary treatment for subfoveal myopic choroidal neovascularization (CNV).

Methods

In all, 37 treatment-naïve eyes of 37 patients with subfoveal myopic CNV who received intravitreal bevacizumab (n=22) or ranibizumab (n=15) injections with at least 2 years of follow-up were reviewed. All eyes received initial three loading doses of anti-VEGF at monthly intervals and retreatment was performed in persistent or recurrent CNV. Multivariate regression analyses were performed to determine the prognostic factors for visual outcome.

Results

The mean age was 57.3 years and the mean refractive error was −11.7 D. For all eyes, the mean logMAR best-corrected visual acuity improved from 0.86 (20/145) at baseline to 0.48 (20/60) at 2 years (P<0.001). The mean visual improvement for the bevacizumab and ranibizumab groups at 2 years was 2.8 and 5.1 lines, respectively (P=0.073). There was no significant difference in the proportion of eyes having visual gain of three or more lines or visual loss of three or more lines between the two groups. The mean number of injections was 3.8 for both bevacizumab and ranibizumab groups. Multivariate analyses showed that eyes with higher myopic refractive error were less likely to have visual gain after treatment (P=0.043), while size of CNV was negatively correlated with mean change in vision (P=0.046).

Conclusions

Intravitreal anti-VEGF therapy resulted in long-term visual improvement in myopic CNV. The treatment efficacy in terms of visual gain and number of retreatment appeared to be similar between bevacizumab and ranibizumab.     

Single-session combined photodynamic therapy with verteporfin and intravitreal anti-vascular endothelial growth factor therapy for chronic central serous chorioretinopathy: a pilot study at 12-month follow-up

Background  

To report the anatomic and functional outcomes of a single-session combined photodynamic therapy with verteporfin (PDT) and intravitreal (IVT) anti-vascular endothelial growth factor (anti-VEGF) in patients with chronic central serous chorioretinopathy (CCSCR).     

积极稳妥地进行治疗效果优化及新适应证探索研究,不断提高科学使用抗血管内皮生长因子药物治疗眼底病的临床应用水平

抗血管内皮生长因子(VEGF)药物治疗已经成为新生血管性老年性黄斑变性的临床一线治疗,在糖尿病黄斑水肿、视网膜静脉阻塞继发黄斑水肿以及早产儿视网膜病变、新生血管性青光眼等视网膜新生血管病变相关的疾病治疗中也得到广泛应用并取得良好的临床效果.然而,积极稳妥地进行治疗效果优化以及新的适应证探索研究,在国内外研究的基础上,结合本地区特点和患者具体情况,不断提高科学使用抗VEGF药物治疗眼底病的临床应用水平仍有大量工作要做;进一步深入研究新生血管性眼底疾病的本质特征以及影响其发生发展转归的相关因素,开发研究更新更好的治疗药物及方法尚任重道远.     

玻璃体注射抗VEGF药物对全身VEGF浓度的影响

脉络膜视网膜疾病已经成为影响人类视力的严重问题,血管内皮生长因子(vascular endothelial growth factor, VEGF)的异常表达导致眼底血管通透性增加和新生血管的形成。玻璃体抗VEGF药物注射可快速抑制眼内VEGF水平,有效控制疾病发展,目前抗VEGF治疗已成为眼科广泛应用的治疗手段。然而,研究表明玻璃体内抗VEGF药物进入循环系统后降低血浆VEGF浓度,药物无意义的脱靶效应可能导致全身不良反应。对于高龄患者、患有严重合并症患者、哺乳期妇女、早产儿等特殊人群,应关注多次注射后的全身VEGF抑制。本文通过探讨抗VEGF治疗的药物代谢动力学、全身不良反应、对侧眼效应、对母乳和早产儿的影响,对玻璃体注射抗VEGF药物的全身影响进行综述,以期对临床抗VEGF治疗提供可参考的信息。