雷珠单抗和阿柏西普对年龄相关性黄斑变性患者外层视网膜管状结构的影响

目的分析雷珠单抗和阿柏西普对年龄相关性黄斑变性(age-related macular degeneration,AMD)患者外层视网膜管状结构(outer retinal tubulation,ORT)的影响。方法收集2016年2月至2018年1月医院收治的110例(142眼)AMD患者的临床资料,按治疗方式分为雷珠单抗组(65例82眼)与阿柏西普组(45例60眼),均完成术后2 a随访,记录治疗前后两组患者视力、黄斑中心凹厚度(central foveal thickness,CFT)及ORT的变化。结果基线、治疗后6个月两组治疗眼数比较差异均无统计学意义(均为P>0.05),治疗后12个月、24个月雷珠单抗组治疗眼数比例(86.59%、26.83%)均高于阿柏西普组(55.00%、0,均为P<0.05)。两组治疗后6个月、12个月、24个月最佳矫正视力均有不同程度上升[雷珠单抗组:77.18±10.21、74.24±12.46、73.36±10.71;阿柏西普组:75.45±13.56、75.71±14.74、72.65±11.99],均高于同组治疗前[59.15±13.92、59.21±14.01](均为P<0.05),但组间差异均无统计学意义(均为P>0.05)。两组治疗后6个月、12个月、24个月CRT[雷珠单抗组:(345.22±30.71)μm、(340.37±41.05)μm、(341.67±42.02)μm;阿柏西普组:(346.87±29.68)μm、(341.65±42.65)μm、(343.41±40.87)μm]均较治疗前[(389.57±58.65)μm、(388.67±57.54)μm]降低(均为P<0.05),但组间不同时间点比较差异均无统计学意义(均为P>0.05)。治疗后6个月、12个月、24个月两组ORT(雷珠单抗组:34.15%、46.34%、60.98%;阿柏西普组:40.00%、60.00%、68.33%)均较基线上升(18.29%、23.33%),但组间比较差异均无统计学意义(均为P>0.05)。结论湿性AMD患者ORT患病率随时间的推移增加,抗VEGF药物治疗可改善患者视力及黄斑形态,但无法抑制ORT进展,必须重视鉴别ORT与视网膜下液及水肿,减少过度治疗。

Effects of ranibizumab and aflibercept on outer retinal tubulation of patients with age-related macular degeneration

Objective　To analyze the effects of ranibizumab and aflibercept on outer retinal tubulation (ORT) of patients with age-related macular degeneration (AMD).Methods　The clinical data of 110 patients (142 eyes) with AMD admitted to the hospital from February 2016 to January 2018 were collected.They were divided into ranibizumab group (65 patients,82 eyes) and aflibercept group (45 patients,60 eyes) according to treatment methods.All patients underwent postoperative follow-up for 2 year.The changes in visual acuity,central foveal thickness (CFT) and ORT in both groups were recorded before and after treatment.Results　There was no significant difference in the number of treated eyes between the two groups at baseline and at 6 months after treatment (all P>0.05).The proportion of number of treated eyes in ranibizumab group at 12 months and 24 months after treatment was higher than that in aflibercept group ［(86.59%,26.83%) vs.(55.00%,0)］ (all P<0.05).The best corrected visual acuity at 6 months,12 months and 24 months after treatment was 77.18±10.21,74.24±12.46,73.36±10.71 in the ranibizumab group,and 75.45±13.56,75.71±14.74,72.65±11.99 in the aflibercept group,which were increased in both groups to different degrees,and the above data were higher than those before treatment in the same group ［59.15±13.92,59.21±14.01］ (all P<0.05),but there were no significant differences between the two groups (all P>0.05).The CRT at 6 months,12 months and 24 months after treatment was (345.22±30.71)μm,(340.37±41.05)μm,(341.67±42.02)μm in the ranibizumab group,and (346.87±29.68)μm,(341.65±42.65)μm,(343.41±40.87)μm in the aflibercept group,which was decreased in both groups compared with those before treatment ［(389.57±58.65)μm,(388.67±57.54)μm］ (all P<0.05),but there were no significant differences between the two groups at different time points (all P>0.05).The incidence of ORT in the two groups increased at 6 months,12 months and 24 months after treatment (Ranibizumab group:34.15%,46.34%,60.98%.Aflibercept group:40.00%,60.00%,68.33%) compared with those at baseline (18.29%,23.33%),but there were no significant differences between the two groups (all P>0.05).Conclusion　The prevalence of ORT in patients with wet AMD increases over time.Anti-VEGF drug therapy can improve visual acuity and macular morphology,but cannot inhibit ORT progression.It is necessary to pay attention to the identification of ORT,subretinal fluid and edema in order to reduce over-treatment.