不同抗VEGF药物治疗糖尿病性黄斑水肿的疗效及其与OCT分型的关系

目的:探究不同抗血管内皮生长因子(VEGF)药物治疗糖尿病性黄斑水肿(DME)临床疗效,并分析其与光学相干断层扫描(OCT)分型的关系。方法:选取45例进行雷珠单抗治疗的DME患者(本院于2020-02/2022-02收治)作为雷珠单抗组,同期45例进行康柏西普治疗的DME患者作为康柏西普组。其中雷珠单抗组给予视网膜光凝术联合雷珠单抗治疗,康柏西普组给予视网膜光凝术联合康柏西普治疗。比较两组患者症状改善情况(黄斑水肿改善时间、视网膜厚度恢复正常时间、新生血管消失时间及眼底出血吸收时间),血清白细胞介素-6(IL-6)、VEGF水平,黄斑中心凹视网膜厚度(CMT)、最佳矫正视力(BCVA)水平及并发症发生情况,并分析其临床疗效与不同OCT分型的关系。结果:两组黄斑水肿改善时间、视网膜厚度恢复正常时间、新生血管消失时间及眼底出血吸收时间比较均无明显差异(P>0.05);与治疗前比较,两组治疗后血清IL-6、VEGF、BCVA值均明显降低(P<0.01),但组间比较均无明显差异(P>0.05);与治疗前比较,两组治疗后CMT均明显降低(P<0.05),且与雷珠单抗组比...     

糖尿病黄斑水肿对抗VEGF药物治疗的不同反应与糖尿病视网膜病变程度的相关性

目的：通过观察糖尿病黄斑水肿(diabetic macular edema,DME)患者对于玻璃体腔注射抗VEGF治疗的不同反应和糖尿病视网膜病变(diabetic retinopathy,DR)的不同程度之间的相关性,进一步阐释糖尿病黄伴水肿的发病机制和治疗策略。

方法：选择非增生性糖尿病视网膜病变(non proliferative diabetic retinopathy,NPDR)伴发DME的患者27例33眼,增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)伴发DME的患者32例34眼。均给予玻璃体腔注射抗VEGF药雷珠单抗,观察两组患者对该药的不同反应,并进行统计学比较。

结果：分别把患者治疗3、6mo时的最佳矫正视力(best corrected visual acuity,BCVA)和黄斑中心视网膜厚度(central macular thickness,CMT)和治疗前的BCVA、CMT作比较,NPDR组有统计学差异(P<0.05),PDR组无统计学差异(P>0.05)。NPDR组和PDR组比较,3、6mo时的BCVR和CMT均有统计学差异(P<0.05)。

结论：糖尿病视网膜病变的不同程度影响着糖尿病黄斑水肿对抗VEGF治疗的反应。     

阿柏西普和雷珠单抗治疗糖尿病性黄斑水肿的疗效

目的:比较阿柏西普和雷珠单抗治疗糖尿病性黄斑水肿(DME)的疗效。方法:前瞻性随机对照试验。纳入2020-06/2021-09于我院确诊的非增殖期糖尿病视网膜病变合并DME的患者35例60眼,均采用3+PRN方案行玻璃体腔注射治疗,其中17例30眼接受阿柏西普治疗(阿柏西普组),18例30眼接受雷珠单抗治疗(雷珠单抗组)。随访12mo,观察两组患者中心凹厚度(CMT)和最佳矫正视力(BCVA)情况,记录玻璃体腔注射次数和并发症发生情况。结果:治疗后1、3、6、12mo,阿柏西普组CMT和BCVA均明显优于雷珠单抗组(均P<0.001)。随访期间,阿柏西普组玻璃体腔注射次数少于雷珠单抗组(4.23±0.86次vs 6.40±0.97次,P<0.05),两组患者均未出现药物相关不良反应、眼内感染、血管栓塞等严重并发症。结论:阿柏西普和雷珠单抗治疗DME均具有明确的疗效和安全性,相较于雷珠单抗,阿柏西普可能是DME患者更有效和方便的治疗选择。     

玻璃体内注射抗VEGF药物对糖尿病黄斑水肿患者疗效的影响因素分析

目的 探讨玻璃体内注射抗血管内皮生长因子(VEGF)药物对糖尿病黄斑水肿(DME)患者疗效的影响因素。方法 收集2020年1月至2021年8月于郑州市第二人民医院眼科接受玻璃体内注射抗VEGF药物治疗的100例(100眼)DME患者的临床资料。依据患者DME病理学类型将患者分为3组,浆液性视网膜脱离组(40眼)、囊样黄斑水肿组(35眼),弥漫性视网膜增厚组(25眼)。以末次抗VEGF治疗后1个月CMT下降率≥20%为患者黄斑水肿消退疗效达标,反之为未达标。以BCVA提高2行及以上为患者视力提高疗效达标,反之为未达标。比较治疗前及末次治疗后1个月三组患眼最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)。收集所有患者的基本资料、血糖相关指标、血压、血脂指标及生化指标、眼科相关指标。分别采用单因素及多因素Logistic回归分析筛选影响抗VEGF玻璃体内注射对DME患者疗效的独立危险因素。结果 末次治疗后1个月3组患者BCVA(logMAR)、CMT均较治疗前降低,差异均有统计学意义(均为P<0.05)。黄斑水肿消退疗效未达标患者舒张压、高密度脂蛋白(HDL)、基线CMT、感光...     

湿性年龄相关性黄斑变性患者抗血管内皮生长因子治疗敏感性的影响因素:基于房水细胞因子分析

目的　通过分析湿性年龄相关性黄斑变性（wAMD）患者抗血管内皮生长因子（VEGF）治疗后房水细胞因子浓度的改变及房水细胞因子与相关指标之间的相关性,探讨影响wAMD患者抗VEGF治疗敏感性的因素。方法　选取2019年8月至2020年1月于广州中医药大学第一附属医院就诊的wAMD患者（观察组）和白内障患者（对照组）各30例（30眼）,分别收集两组患者研究期间房水,用微球悬浮阵列技术（Luminex200^TM）进行房水细胞因子浓度检测。同时分析观察组患者连续2次抗VEGF（雷珠单抗或康柏西普）治疗前后相关指标［最佳矫正视力、黄斑中心凹视网膜厚度（CMT)］与房水细胞因子之间的相关性。结果　抗VEGF治疗前,观察组患者房水中白细胞介素-8（IL-8）、血管生成素样蛋白4（angiopoietin-like protein 4,ANGPTL4）、单核细胞趋化蛋白-1（MCP-1）浓度均明显高于对照组,差异均有统计学意义（均为P＜0.05）;而两组患者房水中血管内皮生长因子-A（VEGF-A）、白细胞介素-6（IL-6）、血小板源性生长因子-BB（PDGF-BB）细胞因子浓度差异均无统计学意义（均为P＞0.05）;抗VEGF治疗1个月后,观察组患者房水中VEGF-A浓度明显下降,与治疗前相比差异具有统计学意义（Z=-3.589,P＜0.001）;连续2个月抗VEGF治疗后,观察组患者视力提高,CMT降低,差异均有统计学意义（均为P＜0.05）;抗VEGF治疗前后观察组患者房水中PDGF-BB浓度与视力呈负相关（r=-0.413、-0.508,均为P＜0.05）,治疗1个月后MCP-1、IL-6、ANGPTL4浓度与CMT均呈正相关（r=0.743、0.552、0.566,均为P＜0.05）。结论　房水细胞因子IL-8、MCP-1、ANGPTL4可能参与wAMD疾病的发生,抗VEGF治疗能有效改善患者视力及减轻黄斑水肿,其中视力恶化可能与房水细胞因子PDGF-BB浓度有关,而房水细胞因子MCP-1、IL-6、ANGPTL4浓度可能与黄斑水肿有关。     

康柏西普对DME患者黄斑部微循环的影响

目的:观察糖尿病性黄斑水肿(DME)患者注射康柏西普前后黄斑部视网膜浅层毛细血管密度及房水因子的变化,初步探讨康柏西普对DME患者黄斑部微循环的影响.方法:前瞻性病例对照研究.收集2019-12/2020-12就诊于我院眼科的DME患者10例11眼作为DME组,收集15例无全身系统疾病和眼底疾病的白内障患者作为白内障组...     

Reduced effect of anti-vascular endothelial growth factor agents on diabetics with vitreomacular interface abnormalities

This study investigated whether the presence of vitreomacular interface abnormalities (VMIAs) affects the improvement in visual acuity and edema of patients with diabetic macular edema (DME) who received three anti-vascular endothelial growth factor (VEGF) injections. Fifteen eyes of 11 patients with clinically significant macular edema were retrospectively divided into either the control group (only DME) or the experimental group (DME and VMIA) based on optical coherence tomography images. We defined VMIA patterns as epiretinal membrane and/or anomalous vitreomacular adhesion. Changes in central macular thickness (CMT), total macular volume (TMV), and best-corrected visual acuity (BCVA) from the baseline to post third injection were compared between the two groups. After the third injection, the decreases in CMT and TMV were not statistically different between the two groups. The improvement in BCVA was larger in the control group (0.1742 ± 0.0508 logMAR) than in the experimental group (0.0766 ± 0.0562 logMAR; p < 0.01). Our study showed that after the third anti-VEGF injection, the BCVA of patients with both DME and VMIAs improved significantly less than that of patients with only DME. Our results suggest that VMIAs may play a crucial role in reducing the therapeutic effects of anti-VEGF agents.     

亚阈值微脉冲黄激光联合雷珠单抗治疗糖尿病性黄斑水肿

目的:对比亚阈值微脉冲(STMP)黄激光单独和联合玻璃体腔注射雷珠单抗治疗糖尿病性黄斑水肿(DME)的临床效果及安全性。方法:前瞻性临床随机对照研究。选取2017-04/2018-08符合入选标准的DME患者33例58眼,随机分成单纯激光组(16例28眼)行STMP黄激光,联合治疗组(17例30眼)行玻璃体腔注射雷珠单抗联合STMP黄激光。比较治疗前后的最佳矫正视力(BCVA)、眼压、黄斑中心凹视网膜厚度(CMT)、黄斑体积(TMV)、眼底血管造影(FFA)、多焦视网膜电图(MERG)、自发荧光(AF)、黄斑色素光密度(MPOD),并统计治疗次数。结果:BCVA、TMV:单纯激光组治疗后6、9、12mo与治疗前比较均有差异(P<0.05),联合治疗组治疗后3、6、9、12mo与治疗前比较均有差异(P<0.05)。两组治疗后3、6、9、12mo CMT与治疗前比较均有差异(P<0.01)。两组患者治疗后12mo MERG总反应波P 1振幅、黄斑光密度最大值(Max OD)、黄斑区平均光密度(Mean OD)与治疗前比较均有差异(P<0.01)。治疗后12mo,两组间TMV、P 1振幅均有差异(P<0.01)。随访期间单纯激光组激光次数3.32±1.09次,联合治疗组3.30±1.18次(P=0.943)。结论:STMP黄激光单独和联合玻璃体腔注射雷珠单抗均可有效降低DME患者的黄斑水肿、提高视力且安全;联合治疗组起效快、效果更好。     

玻璃体腔注射Ranibizumab联合视网膜光凝治疗视网膜分支静脉阻塞继发黄斑水肿

目的：观察玻璃体腔注射Ranibizumab(雷珠单抗)联合视网膜光凝术对视网膜分支静脉阻塞( branch retinal vein occlusion,BRVO)继发黄斑水肿的治疗效果。
　　方法：确诊为视网膜分支静脉阻塞继发性黄斑水肿的患者42例42眼,随机分为三组,每组14眼。单纯注药组给予玻璃体腔注射Ranibizumab 0.05 mL;单纯光凝组行黄斑格栅样光凝;联合治疗组先行玻璃体腔内注射Ranibizumab,再于注药1wk 后行黄斑格栅样光凝。观察三组治疗前和治疗后1,3,6 mo时患者的最佳矫正视力( BCVA)、黄斑区中心凹厚度( CMT)。
　　结果：三组在治疗前BCVA和CMT组间差异无显著性( P>0.05)。各组在治疗后1,3,6 mo的BCVA和CMT均优于治疗前,差异有统计学意义(P<0.05)。单纯注药组治疗后1,3,6mo 的 BCVA 和 CMT 变化有显著性差异( P<0.05),BCVA呈下降趋势,CMT呈增厚趋势;单纯光凝组和联合治疗组治疗后1,3,6 mo BCVA及CMT变化无显著性差异(P>0.05)。治疗后1,3,6mo,联合治疗组BCVA和CMT优于单纯注药组和单纯光凝组(P<0.05),治疗后3,6 mo,单纯光凝组BCVA和CMT优于单纯注药组(P<0.05)。
　　结论：玻璃体腔注射Ranibizumab联合视网膜光凝可以有效治疗视网膜分支静脉阻塞继发黄斑水肿,提高视力,相比单纯注药或者单纯光凝效果更稳定可靠。     

Comparison of anatomical and functional outcomes of vitrectomy with internal limiting membrane peeling in recalcitrant diabetic macular edema with and without traction in Indian patients

Purpose:To study and compare the outcomes of pars plana vitrectomy (PPV) with the internal limiting membrane (ILM) peeling in the eyes with recalcitrant diabetic macular edema (DME) with and without vitreomacular traction.Methods:A comparative prospective interventional study was undertaken in which group 1 included 45 eyes of 45 patients with DME with vitreomacular tractional component and group 2 included 45 eyes of 45 patients with recalcitrant DME without a tractional component. Both groups underwent standard PPV with ILM peeling. All the patients were followed up for a minimum of 6 months. The parameters evaluated were changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT), multifocal electroretinogram (mfERG) parameters, and occurrence of any intraoperative/postoperative surgical complication.Results:The mean CMT improved significantly from 540.6 and 490.2 μm at the baseline to 292.5 and 270.6 μm at 6 months in groups 1 and 2, respectively (P < 0.001). The mean BCVA logMAR improved from 0.78 ± 0.21 to 0.62 ± 0.22 in group 1 and 0.84 ± 0.19 to 0.65 ± 0.21 in group 2 at 6 months follow-up which was not statistically significant. The improvement in the mfERG was seen in group 2 as a significant increase in P1 wave amplitude in ring 2 (2–5°) (P < 0.004) and a significant decrease in P 1 wave implicit time in ring 1 (central 2°) (P < 0.001). None of the eyes suffered from the loss of BCVA or any major surgical complication in either group.Conclusion:PPV in recalcitrant DME provides good anatomical outcomes and the results are comparable in DME with and without a tractional component.     

玻璃体腔注射Ranibizumab联合激光治疗BRVO继发黄斑水肿的观察

目的：评价玻璃体腔注射ranibizumab(雷珠单抗)联合激光治疗视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)继发黄斑水肿(macular edema)的临床疗效。

方法：经眼底荧光血管造影(fundus fluorescence angiography,FFA)及光学相干断层扫描(optical coherence tomography,OCT)检查确诊为BRVO合并黄斑水肿的患者78例78眼,随机选取A组26例26眼,行黄斑部格栅光凝(grid laser photocoagulation,GLP); B组26例26眼,先行黄斑部格栅光凝,1wk后再行玻璃体腔注射ranibizumab治疗; C组26例26眼,先行玻璃体腔注射ranibizumab治疗,1wk后再行黄斑部格栅光凝,三组黄斑水肿无显著性差异。对比分析三组治疗前,治疗后1wk,1及6mo患者最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心厚度(central macular thickness,CMT)的变化。

结果：治疗后1wk与治疗前相比：A组BCVA平均值、CMT平均值变化差异无统计学意义(P>0.05); B、C组BCVA平均值提高,CMT平均值降低,差异具有统计学意义(P<0.05); 组间比较BCVA变化、CMT变化差异具有显著统计学意义(P<0.01)。治疗后1,6mo与治疗前相比,三组BCVA平均值提高,CMT平均值降低,差异均具有显著统计学意义(P<0.01); 组间比较BCVA变化、CMT变化差异具有统计学意义(P<0.05)。治疗后6mo与治疗后1mo相比,A、B组BCVA平均值、CMT平均值变化差异均无统计学意义(P>0.05); C组BCVA平均值提高,CMT平均值降低,差异具有显著统计学意义(P<0.01); 组间比较BCVA变化、CMT变化差异具有统计学意义(P<0.01)。

结论：玻璃体腔注射Ranibizumab联合激光治疗可有效的减轻BRVO所致黄斑水肿,提升视力; 其作用较单纯GLP治疗起效更迅速、能更好的减轻黄斑水肿; 于黄斑格栅光凝治疗前先行玻璃体腔注射ranibizumab治疗效果更为确切、稳定性更强。     

Ranibizumab for idiopathic epiretinal membranes: A retrospective case series

PurposeTo study the effect of intravitreal ranibizumab on idiopathic epiretinal membranes (ERMs).MethodsA retrospective cohort study on a consecutive series of ranibizumab intravitreal injections for epiretinal membranes was performed. Four cases were identified by reviewing a claims database linked to electronic medical records. All patients received a total of three 0.05 mg/0.05 ml ranibizumab intravitreal injections at a monthly interval. The primary outcome measure was the final best-corrected visual acuity (BCVA) at the end of the injection series, and the final central macular thickness (CMT).ResultsAll four patients completed 3 months follow-up after the last ranibizumab injection. The mean baseline CMT was 509 microns (SD = 111). A trend was noticed for reduction in CMT (Δ = 41 microns) P = 0.08. Three patients improved by one line in their BCVA. The remaining patient maintained the same BCVA. No complications were noted.ConclusionIn this study, intravitreal injection of ranibizumab marginally reduced retinal thickness in four patients with minimal improvement in visual acuity. No safety concerns were noticed. Further basic science and clinical studies may be warranted to assess the role of vascular endothelial growth factor and the effect of ranibizumab on idiopathic epiretinal membranes.     

Efficacy of single-dose dexamethasone implantation in patients with persistent diabetic macular edema

To investigate the efficacy of single-dose intravitreal dexamethasone implantation in the treatment of persistent diabetic macular edema (DME) unresponsive to 3 consecutive ranibizumab injections over a period of 6 months. Forty-one patients with a previous history of treatment for DME including at least three consecutive intravitreal ranibizumab injections were enrolled in this retrospective study. Main outcome measures were change in best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure from baseline to 6th month. At the baseline, the mean CMT was 572.4 ± 123.1 μm which improved to 264.2 ± 114.4, 317.7 ± 141.7, 410.6 ± 169.1, and 382.8 ± 181.5 μm at the 1st, 3rd, 5th, and 6th month, respectively (p < 0.05). The preoperative mean BCVA was 0.85 ± 0.54 logMAR units which improved to 0.76 ± 0.5 (p = 0.08), 0.69 ± 0.4 (p = 0.02), 0.74 ± 0.4 (p = 0.284), and 0.72 ± 0.3 (p = 0.489) logMAR units at the 1st, 3rd, 5th, and 6th months, respectively. Additional injections were required for 13 (31 %) eyes at 3rd month and 14 (34 %) eyes at 5th month due to recurrence of macular edema. Intravitreal dexamethasone implantation caused a significant improvement of BCVA and reduction of CMT in the patients with persistent DME that were unresponsive to 3 consecutive ranibizumab injections. However, retreatment before 6 months in the majority of the patients was needed despite the beneficial effects after the index procedure.     

雷珠单抗联合激光光凝治疗糖尿病性黄斑水肿的疗效

目的：研究雷珠单抗联合激光光凝治疗糖尿病性黄斑水肿(diabetic macular edema,DME)的临床疗效。

方法：选取2014-06/2016-06于我院治疗的190例190眼DME患者的病历资料进行回顾性分析。将单独使用雷珠单抗玻璃体腔注射治疗的90例90眼患者设为对照组,在此基础上联合视网膜激光光凝治疗的100例100眼患者设为观察组。比较两组患者术前、术后最佳矫正视力(best corrected visual acuity,BCVA); 光学相干断层扫描(optical coherence tomography,OCT)测量黄斑中心凹厚度(central macular thickness,CMT); 眼底血管造影(fundus fluorescein angiography,FFA)评价两组患者黄斑水肿渗漏情况; 比较两组患者注药次数; 随访统计并发症发生情况。随访12mo。

结果：观察组治疗后平均BCVA分数均显著高于术前,对照组治疗后1、3、6、12mo显著高于术前,治疗后6、12mo组间比较差异具有统计学意义(P<0.05),治疗后1、3mo组间比较差异无统计学意义(P>0.05); 两组患者治疗后CMT均显著降低,且治疗后1、3、6、12mo观察组显著低于对照组,差异具有统计学意义(P<0.05); 末次随访观察组无黄斑水肿渗漏率为45.0%,显著高于对照组(30.0%),差异具有统计学意义(P<0.05); 观察组注药次数显著低于对照组,差异具有统计学意义(P<0.05); 两组患者术后均无明显并发症。

结论：联合视网膜激光光凝治疗相较于单独采用雷珠单抗治疗,可改善远期视力和黄斑水肿,减少注药次数,且降低CMT效果更佳。     

糖尿病性黄斑水肿患者抗VEGF药物疗效与尿蛋白含量的相关性研究

目的　观察不同尿蛋白含量下糖尿病性黄斑水肿(diabetic macular edema，DME)患者行抗血管内皮生长因子（vascular endothelial growth factor，VEGF）药物治疗的疗效差异并进行影响因素分析。方法　前瞻性研究。选取2018年1月至2018年12月于南昌大学第二附属医院内分泌科及眼科住院或门诊已确诊为2型DME患者82例，根据尿肾功能检查结果将患者分为三组:尿白蛋白含量小于30 mg为正常蛋白尿组（19例），尿白蛋白含量30~300 mg为微量蛋白尿组（16例），尿白蛋白含量大于300 mg为大量蛋白尿组（47例）。收集患者年龄、糖尿病病程、高血压病史、肾功能检验结果［尿蛋白、尿微量白蛋白、N-乙酰-β-D-氨基葡萄糖苷(N-acetyl-β-D-glucosaminidase，NAG）酶］、血生化检验结果［血肌酐、估算肾小球滤过率（estimated glomerular filtration rate,EGFR）、糖化血红蛋白、糖尿病视网膜病变程度、基线最佳矫正视力（best corrected visual acuity，BCVA）、基线黄斑中心凹视网膜厚度（center macular thickness，CMT）。所有患眼玻璃体内注射康柏西普，均为每月注射1次，连续注射3次，随访3个月。对比分析三组患者治疗后1周、1个月、2个月、3个月的BCVA及CMT资料；以CMT降低≥20％为黄斑水肿消退疗效敏感，反之为疗效不敏感；以BCVA提高2行及以上为视力提高疗效敏感，反之为疗效不敏感。单因素及二分类Logistics回归分析影响三组患者行抗VEGF药物治疗后视力提高疗效及水肿消退疗效的因素。结果　三组患者行抗VEGF治疗后1周、1个月、2个月、3个月的视力提高疗效、黄斑水肿消退疗效敏感率正常蛋白尿组为68.0％、100.0％、94.7％、94.7％和10.5％、73.7％、100.0％、100.0％，微量蛋白尿组为50.0％、87.5％、87.5％、87.5％和0、62.5％、87.5％、93.8％，大量蛋白尿组为19.0％、42.6％、42.6％、31.9％和0、25.5％、36.2％、23.4％；尿蛋白含量越低，治疗后视力提高疗效、黄斑水肿消退疗效越敏感；三组患者治疗后不同时间点的视力提高疗效、黄斑水肿消退疗效差异均有统计学意义（均为P<0.05）。单因素分析结果显示，EGFR、尿蛋白、尿微量白蛋白、NAG酶、糖尿病病程、蛋白尿分组、基线CMT与治疗后3个月视力提高疗效均有关（均为P<0.05）；血肌酐、EGFR、尿蛋白、尿微量白蛋白、NAG酶、高血压、蛋白尿分组、基线CMT与患者治疗后3个月的黄斑水肿消退疗效均有关（均为P<0.05）；二分类Logistics回归分析结果显示，尿蛋白含量是影响DME患者行抗VEGF治疗后3个月视力提高疗效（OR=1.03，95％CI为1.01~1.12）及黄斑水肿消退疗效（OR=1.21，95％CI为1.09~1.43）的独立危险因素（均为P<0.05）。结论　DME患者尿蛋白含量越低，经抗VEGF药物治疗后视力提高疗效、黄斑水肿消退疗效越好，尿蛋白水平高是DME患者行抗VEGF药物疗效的独立危险因素。     

A comparison of responses to intravitreal bevacizumab,ranibizumab, or aflibercept injections for neovascular age-related macular degeneration

Purpose

To compare the responses of intravitreal injections of bevacizumab, ranibizumab, or aflibercept for the treatment of neovascular age-related macular degeneration (nAMD).

Methods

This retrospective study examined 232 eyes of 232 patients who received intravitreal anti-vascular endothelial growth factor (VEGF) injections due to treatment-naïve nAMD. All patients, who were followed-up for at least 1 year, were treated with intravitreal injections monthly until 3 months, and then as needed. We evaluated the effects of intravitreal injections for treatment of nAMD using the central macular thickness (CMT), subretinal fluid (SRF), pigment epithelial detachment (PED) size, and best-corrected visual acuity (BCVA).

Results

CMT, SRF, PED size, and BCVA (LogMAR) were significantly decreased after treatment with all three anti-VEGF agents. Overall, the bevacizumab, ranibizumab, and aflibercept treatments showed no significant differences in their responses. However, the aflibercept injections decreased PED size more quickly than bevacizumab injections (P = 0.034).

Conclusions

Bevacizumab, ranibizumab, and aflibercept injections are effective treatments for nAMD and have similar responses, although the number of injections of aflibercept was fewer than other anti-VEGF agents. In addition, aflibercept injections may be a better choice than other anti-VEGF agents for cases of severe increases in PED height.

     

Ranibizumab as an adjunct to laser for macular edema secondary to branch retinal vein occlusion

Purpose:

To compare the safety, efficacy, and dosing regimen of intravitreal ranibizumab as an adjunct to laser therapy for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO).

Materials and Methods:

Thirty eyes of 30 patients of BRVO of at least 6 weeks duration were randomized into three groups: Group 1 received grid laser treatment alone, Group 2 received a single dose of intravitreal injection of ranibizumab (0.5 mg / 0.05 ml) followed by grid laser treatment on 7^th day following injection, while Group 3 received three loading doses of intravitreal ranibizumab at monthly interval (i.e. 0, 1, & 2 months) + standard laser treatment 7 days after the 1^st injection. Outcome measure noted at 6 months follow-up were the improvement in best-corrected visual acuity (BCVA) and central macular thickness (CMT).

Results:

At 6 months follow-up, there was an average gain of 12 letters (P=0.05), 17.5 letters (P=0.05) and 19 letters (P=0.05) in groups 1, 2, and 3, respectively, with the decrease in CMT being 208.7 μm (P=0.05), 312.9 μm (P= 0.05) and 326.8 μm (P=0.05), respectively, in these groups. Gain in BCVA of more than 3 lines was noted in 1/10 patients in Group 1(10%) as compared to 3/10 (30%) and 4/10 (40%) patients in groups 2 and 3, respectively.

Conclusion:

The gain in BCVA and reduction in CMT were better with combination therapy (single- and triple- dose regimen) compared to grid laser alone. Single dose of intravitreal ranibizumab with grid laser seems to be an effective therapy.     

激光光凝联合抗VEGF药物不同时机治疗糖尿病视网膜病变的疗效比较

目的:探究激光光凝联合抗血管内皮生长因子(VEGF)药物不同时机治疗糖尿病视网膜病变(DR)的临床效果。方法:前瞻性研究。将2018-01/2019-01我院收治的120例191眼DR患者按随机数字表法分为A(单纯激光光凝,30例44眼)、B(玻璃体腔注射雷珠单抗,30例46眼)、C(激光光凝后延迟玻璃体腔注射雷珠单抗,30例49眼)、D组(玻璃体腔注射雷珠单抗后延迟激光光凝,30例52眼)。激光光凝和/或抗VEGF药物治疗完毕后随访6mo,比较各组患者治疗前后最佳矫正视力(BCVA)、眼压、黄斑中心凹厚度(CMT),观察激光光凝和抗VEGF治疗情况及并发症和糖尿病性黄斑水肿复发情况。结果:治疗前四组患者BCVA和CMT均无差异(P>0.05),治疗后1wk,1、3、6mo BCVA和CMT均较治疗前改善(P<0.05),且C、D组患者治疗后不同时间BCVA、CMT均优于A、B组(P<0.05),D组患者治疗后1wk,1、3mo BCVA、CMT均优于C组(P<0.05)。治疗前后四组患者眼压均无明显变化(P>0.05)。C、D组患者激光参数及次数均低于A组,且D组患者激光参数均低于C组(P<0.05);C、D组患者玻璃体腔注药次数均少于B组(P<0.05),但C、D组患者激光次数和注药次数均无差异(P>0.05)。随访期间,四组患者并发症发生率及糖尿病性黄斑水肿复发率均无差异(P>0.05)。结论:抗VEGF药物玻璃体腔注射后延迟激光光凝治疗DR疗效优于单纯激光光凝、单纯玻璃体腔注射及激光光凝后延迟玻璃体腔注射,可改善患者BCVA,减轻黄斑水肿,减少激光能量、激光次数及抗VEGF注药次数,同时安全性肯定。     

Aflibercept Treatment for Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy Refractory to Anti-vascular Endothelial Growth Factor

Purpose

To report the results of switching treatment to vascular endothelial growth factor (VEGF) Trap-Eye (aflibercept) in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) refractory to anti-VEGF (ranibizumab and bevacizumab).

Methods

This is a retrospective study involving 32 eyes from 29 patients; 18 were cases of neovascular AMD and 14 were cases of PCV. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) of spectral-domain optical coherence tomography were evaluated.

Results

BCVA and CMT improved from 0.58 to 0.55 (p = 0.005) and from 404 to 321 µm (p < 0.001), respectively, after switching to aflibercept. The 14 eyes that received 6 or more aflibercept injections remained stable at 0.81 to 0.81 and 321 to 327 µm (p = 1.0, 0.29), respectively, after 3 aflibercept injections. The 10 eyes that received 3 or more bevacizumab injections after 3 or more aflibercept injections worsened, from 0.44 to 0.47 and from 332 to 346 µm (p = 0.06, 0.05), respectively. The results showed similar improvement of BCVA and CMT in neovascular AMD and PCV.

Conclusions

Aflibercept seems to be effective for improvement and maintenance of BCVA and CMT for neovascular AMD and PCV refractory to anti-VEGF. Switching from aflibercept back to bevacizumab treatment may not be a proper strategy.     

Outcomes of preoperative bevacizumab in diabetics with nonclearing vitreous hemorrhage without tractional detachment – A quasi-randomized retrospective study

Purpose:To assess whether preoperative bevacizumab (BVZ) in treatment-naïve eyes with proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH) without tractional retinal detachment (TRD) leads to lesser macular edema and better visual outcome compared to eyes that do not receive BVZ.Methods:This quasi-randomized retrospective study included 217 treatment-naïve eyes with nonclearing VH without TRD that had vitrectomy with or without BVZ and had a minimum 6-months follow-up. Postoperative variables, including visual acuity (BCVA), central macular thickness (CMT) at 1 month, and need for additional anti-VEGF injections till 6 months follow-up, were recorded for analysis.Results:Of the 217 eyes, 107 eyes (49%) received preoperative BVZ and 110 (51%) did not. Groups were comparable in terms of preoperative characteristics. At 1 month, mean CMT was significantly higher in eyes without BVZ (310 ± 33 μ vs. 246 ± 34μ; P < 0.001). The likelihood of developing center-involving DME at 1 month after vitrectomy was 67% lower if the eye received preoperative BVZ (OR = 0.33, 95%CI = 0.18–2.54, P = 0.56). Though BCVA improved significantly in both groups at 1 month, it was 1/3^rd of a line better in the BVZ group (β coefficient = −0.035 logMAR, 95%CI = −0.04 to −0.008 logMAR, P = 0.01).Conclusion:Preoperative BVZ in treatment-naïve eyes with PDR and VH but without TRD lead to better macular status and marginally improved vision at 1 month, which was maintained at 6 months. In view of these results, patients may be offered BVZ only when it is readily affordable to them.