玻璃体内注射雷珠单抗治疗病理性近视合并脉络膜新生血管疗效观察

目的　观察玻璃体内注射雷珠单抗治疗病理性近视合并脉络膜新生血管（ｃｈｏｒｏｉｄａｌｎｅｏｖａｓｃｕｌａｒｉｚａｔｉｏｎ,ＣＮＶ）的临床疗效及安全性。方法　回顾性分析１８例１８眼病理性近视患者的临床资料。玻璃体内注射雷珠单抗０．５ｍｇ（０．０５ｍＬ）,术后每个月随访时行最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、眼底彩照、光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）检查,术后１个月、３个月、６个月随访时行眼底荧光血管造影（ｆｌｕｏｒｅｓｃｅｎｃｅｆｕｎｄｕｓａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查。随访过程中发现ＣＮＶ部分闭合或持续渗漏者则再次予以玻璃体内注射雷珠单抗。比较治疗前后ＢＣＶＡ、ＯＣＴ、眼底彩照及ＦＦＡ检查结果,观察其临床疗效及安全性。结果　术后１个月、３个月、６个月随访时,ＢＣＶＡ均较术前明显提高（Ｆ＝１１．３５４,Ｐ＜０．０５）;黄斑中心凹厚度均较术前明显降低（Ｆ＝４．２４２,Ｐ＜０．０５）。术后６个月随访时,１６眼视力提高２行以上,２眼视力稳定;眼底彩照示所有患眼黄斑区出血吸收,ＦＦＡ检查示１４眼ＣＮＶ完全闭合,４眼大部分闭合。玻璃体内注射雷珠单抗平均次数为２．５６次,其中３眼行１次,８眼行２次,５眼行３次,２眼行４次。随访期间所有患者均未出现眼部及全身并发症。结论　玻璃体内注射雷珠单抗治疗病理性近视合并ＣＮＶ是安全有效的。     

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.     

Marginal crack after intravitreal bevacizumab for myopic choroidal neovascularization

Purpose: To report new indocyanine green angiographic (ICGA) findings after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV). Cases report: Three eyes of three patients with mCNV were examined with fluorescein angiography (FA) and ICGA using Heidelberg Retinal Angiograph 2 and the conventional fundus camera before and after IVB. The cessation of angiographic leakage on FA was achieved in all eyes (100%) after IVB, however the hypofluorescent line delineating the margin of the neovascular tissue appeared in ICGA seemingly according to the contraction of mCNV. It was not detected either on FA or ICGA with the conventional camera. This hypofluorescence line enlarged over the time. Conclusion: The contraction‐associated hypofluorescence line, namely marginal crack line, indicates the early damage of retinal pigment epithelium and seems to lead to expanding macular chorioretinal atrophy typically seen in mCNV.     

Outcome of intravitreal bevacizumab for idiopathic choroidal neovascularization in a Chinese population

Objective: To assess the long-term visual and anatomical outcomes and safety of intravitreal injection of bevacizumab for idiopathic choroidal neovascularization (ICNV) in Chinese patients.Design: Retrospective interventional case series.Participants: Seventy-seven eyes of 77 patients with ICNV.Methods: Patients were given intravitreal injection of bevacizumab (1.25 mg/0.05 mL) for ICNV between March 2006 and May 2008. Main outcome measures were changes in best-corrected visual acuity (BCVA), central foveal thickness, which was measured by optical coherence tomography, and fluorescein angiography findings.Results: Mean follow-up was 14.3 (SD 2.4, range 10∼20) months. Mean BCVA improved from 0.66 (SD 0.36) logMAR at baseline to 0.25 (SD 0.28) logMAR at final follow-up (p < 0.001). Sixty-one patients (79%) gained BCVA of ≥2 Snellen lines, and 1 eye (1%) lost BCVA of ≥2 Snellen lines. Mean central foveal thickness decreased from 365 (SD 124) μm at baseline to 211 (SD 94) μm at final visit (p < 0.001). Sixty-two eyes (81%) needed reinjection. Both BCVA improvement and the change in central foveal thickness between the 1 — time injection group and the multi-injections group were not statistically significant (p = 0.45 and p = 0.19, respectively). No significant ocular or systemic adverse effects were observed.Conclusions: The long-term results suggest an encouraging efficacy and safety of intravitreal bevacizumab for ICNV in Chinese patients.     

Intravitreal bevacizumab and ranibizumab injections for patients with polypoidal choroidal vasculopathy

Purpose

To compare the effectiveness of intravitreal injection of bevacizumab and ranibizumab in patients with treatment-naïve polypoidal choroidal vasculopathy (PCV).

Methods

A total of 66 and 60 eyes of 121 consecutive patients who received intravitreal bevacizumab (1.25 mg) or ranibizumab (0.5 mg) injection for treatment of PCV were retrospectively reviewed. After initial three loading injections by month, injection was performed as needed. Main outcome measures included best corrected visual acuity (BCVA), foveal center thickness (FCT) as assessed by spectral domain optical coherence tomography (SD-OCT), and change in polypoidal lesion on indocyanine green angiography (ICGA).

Results

At 12 months, average number of injections was 4.72±1.84 in the bevacizumab group and 5.52±1.54 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline at 12 months after injection improved by 0.11 in the bevacizumab group (P=0.02) and by 0.14 in the ranibizumab group (P=0.01). Average FCT decreased from 368±62.48 to 298±40.77 μm in the bevacizumab group (P=0.01) and from 371±50.79 to 286±36.93 μm in the ranibizumab group (P=0.01). Polyp regression rate was 24.2% (16 eyes out of 66 eyes) in the bevacizumab group and 23.3% (14 eyes out of 60 eyes) in the ranibizumab group. There was no statistically significant difference in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups.

Conclusion

Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilization of visual acuity, macular edema, and regression of polypoidal complex with PCV eyes.     

玻璃体内注射雷珠单抗治疗特发性脉络膜新生血管疗效观察

目的　观察雷珠单抗治疗特发性脉络膜新生血管（ｉｄｉｏｐａｔｈｉｃｃｈｏｒｏｉｄａｌｎｅｏｖａｓｃｕｌａｒｉｚａｔｉｏｎ,ＩＣＮＶ）的有效性和安全性。方法　采用非随机对照临床回顾性研究,对１８例１８眼经间接眼底镜、光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈ,ＯＣＴ）、眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈ,ＦＦＡ）检查确诊的ＩＣＮＶ患者,行玻璃体内注射０．５ｍｇ雷珠单抗治疗。术后每个月随访１次,６个月后若病情稳定可改为每２个月随访一次,随访时经ＯＣＴ、ＦＦＡ证实病情反复者则眼内重复注射。统计分析治疗期间的最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、黄斑中心凹视网膜厚度（ｃｅｎｔｒａｌｒｅｔｉｎａｔｈｉｃｋｎｅｓｓ,ＣＲＴ）、眼部及全身不良反应。结果　１８例１８眼患者均完成６～１２个月的随访,治疗前患者的ＢＣＶＡ为４５．００±１．００,治疗后１周、１个月、３个月、６个月及末次随访时的ＢＣＶＡ分别为５５．８９±４．２３、６４．２２±９．３５、７３．００±７．４４、７６．１７±６．６２、７３．７２±５．９２,与治疗前比较差异有统计学意义（Ｐ＜０．０５）。治疗前患者的ＣＲＴ为（３３８．４４±３７．８５）μｍ,治疗后１周、１个月、３个月、６个月及末次随访时的ＣＲＴ分别是（２８９．２２±３２．５３）μｍ、（２３７．６７±３２．４５）μｍ、（２１６．０６±２５．１１）μｍ、（２１５．３９±２０．４１）μｍ、（２００．３９±１５．１０）μｍ,与治疗前比较差异有统计学意义（Ｐ＜０．０５）。随访过程中未发现全身不良反应及眼部严重并发症。结论　玻璃体内注射雷珠单抗能快速有效地提高ＩＣＮＶ患者的ＢＣＶＡ,稳定病情,但必要时需重复注射。     

玻璃体内注射雷珠单抗治疗病理性近视继发脉络膜新生血管

目的　对比观察玻璃体内注射雷珠单抗的两种方案治疗病理性近视（pathological myopia,PM）继发脉络膜新生血管（choroidal neovascularization,CNV）的临床疗效。方法　收集2016年1月至2017年6月在我院接受治疗的PM-CNV患者49例（49眼）纳入本研究。所有患眼均行玻璃体内注射雷珠单抗（0.05 mL,含雷珠单抗0.5 mg）治疗。依据接受治疗情况将患者分为1+PRN组（注射一次后再按需注射）25例25眼、3+PRN组（连续注射3个月后再按需注射）24例24眼。随访时间为12个月。比较治疗后两组患眼的平均治疗次数、最佳矫正视力（best corrected visual acuity,BCVA）、黄斑中心凹视网膜厚度（central macular thickness,CMT）以及CNV渗漏变化情况。结果　1+PRN组、3+PRN组患眼治疗次数分别为（1.92±1.12）次、（3.21±0.42）次,差异有统计学意义（Z=-4.056,P=0.000）。治疗后6个月、12个月,1+PRN组患眼BCVA分别为（0.57±0.28）logMAR、（0.50±0.26）logMAR,3+PRN组患眼BCVA分别为（0.58±0.22）logMAR、（0.51±0.25）logMAR,两组治疗后同一时间点BCVA比较,差异均无统计学意义（t=-0.214、-0.172,P=0.831、0.864）。治疗后6个月、12个月,1+PRN组患眼CMT值分别为（285.16±66.08）μm、（247.40±55.10）μm,3+PRN组患眼CMT值分别为（286.29±29.53）μm、（241.04±35.39）μm,两组治疗后同一时间点CMT比较,差异均无统计学意义（t’=-0.080、-0.480,P=0.938、0.632）。治疗后12个月,1+PRN组、3+PRN组治疗总有效率分别为84%、92%,两组患眼CNV渗漏治疗总有效率的比较,差异无统计学意义（χ²=0.146,P=0.702）。结论　1+PRN方案在保证疗效的前提下减少了注药次数,提示1+PRN方案更适合于PM-CNV的治疗。     

PDT联合玻璃体腔注射ranibizumab治疗病理性近视继发CNV

目的：评价光动力疗法（ photodynamic therapy,PDT）联合玻璃体腔注射 ranibizumab 治疗病理性近视（ pathologic myopia,PM ）所致的黄斑部脉络膜新生血管（ choroidal neovascularization,CNV）的临床疗效。 方法：临床确诊为PM合并CNV患者32例32眼,随机选取16例16眼为PDT治疗（ PDT组）,另16例16眼为PDT联合玻璃体腔注射ranibizumab治疗组（联合组）,两组黄斑水肿无显著性差异。对比分析治疗前及治疗后1,6 mo患者最佳矫正视力（ best corrected visual acuity,BCVA）、光学相干断层扫描（ optic coherence tomograph,OCT）及眼底荧光血管造影（ fundus fluorescein angiography,FFA）的变化。结果：治疗后1 mo与治疗前相比：PDT组BCVA平均值提高,黄斑中心厚度（ fovea centralis thickness, CMT ）平均值降低,差异具有统计学意义（ P〈0.05）;联合组BCVA平均值明显提高,CMT平均值明显降低,差异具有显著统计学意义（ P〈0.01）;两组组间比较BCVA变化、CMT变化差异具有统计学意义（P〈0.05）。治疗后6mo与治疗前相比, PDT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）;联合组BCVA平均值明显提高,CMT 平均值明显降低,差异具有显著统计学意义（ P〈0.01）;两组组间比较BCVA变化、CMT变化差异具有统计学意义（ P〈0.05）。治疗后6 mo 和1 mo 相比：PDT 组与联合组BCVA平均值、CMT 平均值差异均无统计学意义（ P〉0.05）。 FFA检查显示：治疗后1mo,PDT组 CNV病灶渗漏停止或渗漏减少者11眼（69%）,持续渗漏5眼（31%）;联合治疗组 CNV病灶渗漏停止或渗漏减少者13眼（81%）,持续渗漏3眼（19%）。治疗后6 mo：PDT 组CNV病灶渗漏停止或渗漏减少者10眼（62.5%）,持续渗漏4眼（25%）,2眼（12.5%）出现渗漏复发;联合治疗组CNV病灶渗漏停止或渗漏减少者15眼（94%）,持续渗漏1眼（6%）。 结论：PDT治疗与PDT联合玻璃体腔注射ranibizuma     

A case of intravitreal bevacizumab injection for the treatment of choroidal neovascularization in angioid streaks

A 56-year-old Korean woman presented with decreased visual acuity of the right eye. She had a history of two photodynamic therapy treatments for choroidal neovascularization (CNV) due to angioid streaks in her left eye with central scarring and low visual acuity. She was diagnosed with subfoveal CNV due to angioid streaks in her right eye and treated with six intravitreal bevacizumab (1.25 mg / 0.05 mL) injections over one year. Best corrected visual acuity improved from 20 / 125 at baseline to 20 / 50 at the final visit. The area of CNV had changed into a fibrotic scar by the final visit, and fluorescein angiography and indocyanine green angiography revealed no evidence of leakage. Optical coherence tomography showed that central macular thickness decreased from 311 μm at baseline to 203 μm with complete resolution of subretinal and intraretinal fluid at the final visit. Intravitreal bevacizumab for CNV associated with angioid streaks prevented the progression of disease and resulted in the improvement of visual acuity after one year of follow-up in our patient.     

玻璃体腔注射Bevacizumab治疗特发性脉络膜新生血管的临床观察

目的观察玻璃体腔注射Bevacizumab治疗特发性脉络膜新生血管的临床效果。方法采用非随机对照临床回顾性研究,对经直接或间接检眼镜、荧光素眼底血管造影和吲哚青绿脉络膜血管造影以及光学相干断层扫描检查确诊的特发性脉络膜新生血管患者共32例(32眼),病程10d～1a,行玻璃体腔注射25g.L-1Bevacizumab治疗,注射次数为1～3次,间隔4周,治疗后随访4～18个月,对比分析术前与末次随访的视力、眼底、荧光素眼底血管造影和吲哚青绿脉络膜造影检查显示的渗漏以及光学相干断层扫描检查显示的平均中央视网膜厚度的变化。结果术前和末次随访时平均logMAR视力分别为0.23590±0.19751和0.39750±0.27287,治疗前后比较差异有显著统计学意义(t=-5.530,P<0.001)。OCT显示术前平均中央视网膜厚度为(317.72±75.01)μm,末次随访为(206.28±31.56)μm,治疗前后比较差异有显著统计学意义(t=8.857,P<0.001)。造影显示渗漏消失者18眼,减少者12眼,渗漏持续者2眼。随访期间有5眼出现小片结膜下出血,1眼出现少量玻璃体腔出血,注射后第2天3眼眼压有明显下降,未见其他并发症。2例病情复发,复发率为6.25%,复发病例进行再次注射治疗仍有疗效。结论玻璃体腔注射Bevacizumab治疗特发性脉络膜新生血管安全有效,但其长期的疗效和安全性评价尚需进行多中心、大样本的临床随机对照研究。     

Intravitreal bevacizumab for the treatment of choroidal neovascularization associated with pathological myopia

Background: The recent discovery of vascular endothelial growth factor and its role in the pathogenesis of ocular neovascularization has led to the development of new pharmacological agents that could block its action. This study was carried out to investigate the effect of intravitreal injections of bevacizumab on choroidal neovascularization (CNV) associated with pathological myopia.Methods: We retrospectively reviewed the charts of all patients who had CNV secondary to pathological myopia and who had been treated with intravitreally administered bevacizumab between November 2005 and April 2007 at Notre-Dame Hospital in Montréal, Québec. Data on best-corrected visual acuity (BCVA), previous treatments, number of injections, fundus photography, and fluorescein angiography were collected.Results: Ten eyes from 9 patients were followed for a mean period of 9.7 (range 2.5-14) months.At baseline the mean (SD) logMAR BCVA was 0.62 (0.25) (Snellen equivalent 6/24). The mean number of injections per eye was 2.6 (range 1-5). At the end of the study the mean (SD) logMAR BCVA had significantly improved to 0.26 (0.16) (Snellen equivalent 6/10.5; p < 0.001).Vision improved by a mean of 3.9 (range 0-7) lines on the Snellen visual acuity chart. Leakage from the CNV on fluorescein angiography had resolved in 7 of the 10 eyes and was reduced in the 3 other eyes. No drug-related side effects or complications were observed during the follow-up period.Interpretation: Intravitreal injection of bevacizumab appears to be a safe and effective treatment alternative for CNV associated with pathological myopia.     

Photodynamic monotherapy or combination treatment with intravitreal triamcinolone acetonide, bevacizumab or ranibizumab for choroidal neovascularization associated with pathological myopia

This retrospective, interventional case series analyses treatment outcomes in eyes with choroidal neovascularization (CNV) secondary to pathological myopia, managed with photodynamic therapy, (PDT), (Group 1, N = 11), PDT and intravitreal triamcinolone acetonide (4 mg/0.1ml) (Group 2, N = 3), PDT and intravitreal anti-vascular endothelial growth factor (anti-VEGF) bevacizumab 1.25 mg/0.05 ml, ranibizumab 0.5 mg/0.05 ml and reduced-fluence PDT and intravitreal ranibizumab 0.5 mg/0.05 ml (Group 3, N=12). All the patients underwent PDT. Intravitreal injections were repeated as required. SPSS 14 software was used to evaluate the data. Wilcoxon signed ranks test was used to evaluate pre- and post-treatment vision. The Kruskal-Wallis test was used for comparison between the groups. All the groups were statistically comparable. All the eyes showed complete regression of CNV, with a minimum follow-up of six months. All groups had visual improvement; significantly in Group 3 ( p = 0.003). Combination PDT with anti-VEGF agents appeared to be efficacious in eyes with myopic CNV. However, a larger study with a longer follow-up is required to validate these results.     

比较雷珠单抗和贝伐珠单抗对新生血管AMD的疗效

目的：比较玻璃体内注射雷珠单抗与贝伐珠单抗对年龄相关性黄斑变性（ age-related macular degeneration, AMD）的疗效,治疗方案必要时采用。 方法：回顾性分析63例63眼（雷珠单抗治疗组35眼,贝伐珠单抗治疗组28眼）新确诊新生血管年龄相关性黄斑变性患者的资料。治疗12 mo后随访,分析比较两组患者的最佳矫正视力（ BCVA）和黄斑中心凹厚度（ CFT）。采用双尾t检验和单因素方差分析比较两组最佳矫正视力和黄斑中心凹厚度的变化。 结果：雷珠单抗治疗组35眼和贝伐珠单抗治疗组28眼均完成12 mo随访,并记录数据。雷珠单抗治疗组最佳矫正视力均值增加0.1 logMAR;相反,贝伐珠单抗治疗组最佳矫正视力均值下降0.06logMAR（P=0.01）。雷珠单抗治疗组13眼（37%）和贝伐珠单抗治疗组4眼（14%）最佳矫正视力至少增加0.3logMAR。雷珠单抗治疗组平均黄斑中心凹厚度减少41.6μm,贝伐珠单抗治疗组减少8.1μm（P=0.003）。两组平均注射次数是4.46次和4.11次（P〉0.05）。 结论：玻璃体内注射雷珠单抗组在视力和消水肿方面疗效优于贝伐珠单抗组。但是,两种药的疗效和安全性还需要随机的长期临床试验来验证。     

Intravitreal bevacizumab for choroidal neovascularization secondary to Vogt-Koyanagi-Harada syndrome

Background  Vogt-Koyanagi-Harada (VKH) syndrome is characterized by bilateral diffuse uveitis associated with auditory, neurological, and cutaneous signs and symptoms. VKH syndrome is a cell-mediated autoimmune disease against melanocytes. Choroidal neovascularization (CNV) occurs in 15% of VKH patients and is associated with poor visual prognosis. Cases  We report on two patients with VKH syndrome and CNV that were treated with intravitreal bevacizumab. Observations  One of the VKH patients also had an extrafoveal CNV membrane and underwent multiple intravitreal injections of bevacizumab in combination with laser photocoagulation, with subsequent improvement in visual acuity. The second had a subfoveal CNV that responded to a single intravitreal injection of bevacizumab. Conclusion  Intravitreal bevacizumab may be a useful drug to treat CNV in eyes with VKH syndrome.     

Prognostic factors for visual outcomes 2-years after intravitreal bevacizumab for myopic choroidal neovascularization

Purpose

To determine the pre-treatment ocular factors significantly associated with the visual outcome 24 months after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV).

Methods

A total of 23 eyes of 23 patients with mCNV were treated with IVB followed by as needed therapy. The efficacy of IVB was evaluated by the best-corrected visual acuity (BCVA) at 24 months after the initial treatment. Forward stepwise multiple linear regression analyses were performed to evaluate the influence of pre-treatment factors on the BCVA and the improvement of the BCVA at 24 months.

Results

The mean pre-IVB BCVA was 0.74±0.30 logarithm of the minimum angle of resolution (logMAR) units, and it improved to 0.43±0.31 logMAR units after 1 month (P<0.001, paired t-test). The improvement was maintained at 24 months (0.46±0.40, P<0.005). The mean number of IVB performed during the 24 months was 1.35±0.71. Forward stepwise regression analysis showed that the pre-IVB CNV size (standardized β=0.52, P<0.01) and BCVA (standardized β=−0.44, P<0.05) significantly affected the visual acuity change after 24 months. The CNV size was the only factor that significantly affected the BCVA after 24 months (standardized β=0.56, P<0.01).

Conclusions

IVB with as needed therapy for mCNV led to a rapid and sustained visual improvement. Smaller CNV size was a significant prognostic factor that predicts better visual acuity. Patients with lower pre-treatment BCVA had better visual recovery than those with better pre-treatment BCVA, however, this may be due to a ceiling/floor effect.     

Comparison of visual acuity outcomes between ranibizumab and bevacizumab treatment in neovascular age-related macular degeneration

AIM: To compare visual acuity (VA) outcomes between intravitreal injection of bevacizumab and ranibizumab in the treatment of neovascular age-related macular degeneration (AMD). METHODS: We conducted a consecutive, retrospective case series study in patients with newly diagnosed all type choroidal neovascularization (CNV) secondary to AMD who received an intravitreal injection of bevacizumab (1.25mg) or ranibizumab (0.3mg) at Lions Eye Institute, Western Australia from Mar. 2006 to May 2008. All patients received injection at baseline with additional monthly injections given at the discretion of the treating physician. Main outcome measures were changes in VA. RESULTS: There were 371 consecutive patients received injection at least in one eye with at least 6 months of follow up (median of 12.0 months). Bevacizumab treatment prevented 221 out of 278 (79.5%) patients from losing < 15 letters in VA compared with 79 out of 93 (84.9%) of ranibizumab treated patients (P=0.25). While 68 (24.5%) of bevacizumab treated patients gained ≥15 letters of VA compared with 24 (25.8%) of ranibizumab treated patients (P=0.79). 75.3% and 66.2% patients benefited from ranibizumab and bevacizumab respectively with final VA better than 6/60 (P=0.10). Multivariate analysis showed that pre-treatment VA was negatively associated with benefit outcome. Assignment of injection was not associated with VA outcome of benefit after adjusting the covariate (P=0.857). CONCLUSION: There are no difference in treatment efficacy in terms of VA between bevacizumab and ranibizumab in routine clinical condition.     

OCTA在玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管中的应用

目的:利用光学相干断层扫描血管造影技术观察病理性近视脉络膜新生血管抗VEGF治疗期间的变化,探讨其在监测抗VEGF治疗过程的意义.方法:本研究纳入临床确诊病理性近视脉络膜新生血管患者30例30眼.对患眼行玻璃体腔注射10 mg/mL雷珠单抗0.05mL,治疗后每月随访病情,随访时间为6mo,每次随访均行最佳矫正视力(BCVA)、眼压、裂隙灯、前置镜眼底检查、OCTA检查.比较治疗前、治疗后1、3、6 mo患者BCVA及黄斑中心视网膜厚度(CMT).结果:所有患者平均玻璃体腔注射1.70±0.65次.治疗前平均最佳矫正视力(LogMAR)为0.96±0.17,治疗后1、3、6mo视力分别提高了0.23±0.09、0.34±0.07、0.38±0.11,差异均有统计学意义(t=5.461、8.191、8.894,P<0.05).治疗前平均CMT为281.07±13.72μm,治疗后1、3、6mo分别下降了19.73±9.02、37.62±15.41、46.15±25.16μm,差异均有统计学意义(t=12.007、13.360、9.531,P<0.05).注射后OCTA显示CNV血管网直径缩小,密度降低.结论:玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管疗效显著、安全性高;OCTA能无创、快速获得视网膜和脉络膜血管图像,为诊断病理性近视脉络膜新生血管和监控其治疗效果提供有力工具.     

经瞳孔温热疗法治疗隐匿性脉络膜新生血管

目的:对经瞳孔温热疗法(transpupillary thermotherapy,TTT)治疗隐匿性脉络膜新生血管(occult choroidal neovas-cularization,OCNV)的效果进行评价。方法:眼底荧光素血管造影(fundus fluorescence angiog-raphy,FFA)及吲哚青绿血管造影(indocyanine green angiography,ICGA)检查后确诊为单眼或双眼OCNV患者35例43眼,使用Iris810nm半导体激光进行TTT治疗,选择1.2,2.0及3.0mm直径的光斑,以光斑大小能够完全覆盖FFA及ICGA所显示的病变范围为宜,长脉冲模式,能量80~300mW,照射时间60s。结果:TTT治疗后,18/43眼(42%)视力提高,23/43眼(53%)视力无变化,2/43眼(5%)视力下降;20/43眼(47%)CNV渗漏完全停止,18/43眼(42%)渗漏明显减少,4/43眼(9%)渗漏无改变,1/43眼(2%)渗漏扩大。结论:TTT治疗OCNV效果较好,其适宜的参数及治疗机制还需进一步探讨。     

Intravitreal bevacizumab for subfoveal choroidal neovascularization secondary to age-related macular degeneration in an Indian population

Purpose To investigate the 6-month safety profile and clinical outcomes of intravitreal bevacizumab for treating subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Methods We performed a prospective nonrandomized interventional study of 40 consecutive patients (40 eyes) with subfoveal CNV due to AMD. Patients underwent standard ophthalmic examination, optical coherence tomography, and fundus fluorescein angiography. All patients were administered one or more intravitreal injections of bevacizumab (1.25 mg) as primary therapy. Outcomes were also analyzed in subgroups based on lesion type (classic or occult) and lesion size (≤3000 μm or >3000 μm). Results At the 6 months’ follow-up, mean best-corrected visual acuity (BCVA) improved from 20/160 to 20/100 (P = 0.014), and the mean contrast sensitivity improved from 0.38 to 0.62 (P = 0.001). The mean greatest linear diameter and mean central macular thickness significantly decreased from 3.79 mm to 2.4 mm (P = 0.0001) and from 438.5 μm to 363 μm (P = 0.0001), respectively. Visual acuity gain of 15 letters or more was seen in 20% of patients, and the gain was more in the small-lesion subgroup (31.5%) than in the large-lesion subgroup (9.5%). No significant adverse effects were observed. Conclusion Intravitreal bevacizumab is a safe and effective modality for treatment of CNV secondary to AMD. A significant improvement in BCVA with intravitreal bevacizumab was observed for all lesion types.