湿性年龄相关性黄斑变性患者抗VEGF治疗无效的因素分析和视功能预后

目的　探讨湿性年龄相关性黄斑变性（wAMD）患者玻璃体内注射抗血管内皮生长因子（VEGF）治疗无效的影响因素和视功能预后。方法　回顾性分析97例（97眼）wAMD患者的临床资料，所有患者均进行连续3个月、玻璃体内每个月注射1次抗VEGF治疗。观察并记录患者治疗后最佳矫正视力（BCVA）、黄斑中心凹视网膜厚度（CMT）。根据患者连续3次抗VEGF治疗后1个月的效果分为无效组和有效组。单因素分析筛选wAMD患者抗VEGF治疗无效的危险因素，多因素Logistic回归分析确定治疗无效的独立危险因素；观察治疗无效患者的后续治疗和视功能预后情况。结果　抗VEGF治疗后1个月、2个月、3个月和末次随访时wAMD患者BCVA较治疗前均有明显改善，差异均有统计学意义（均为P<0.05），CMT较治疗前均有减低，差异均有统计学意义（均为P<0.05）。连续3次抗VEGF治疗后1个月，wAMD患者无效21眼（无效组），有效76眼（有效组）。多因素 Logistic 回归分析结果显示:年龄（OR=2.132，95%CI=2.314~44.342，P=0.011）、基线BCVA（OR=8.361，95%CI=7.239~32.764，P=0.009）是抗VEGF治疗无效的独立影响因素。无效组12例（57.1%）更换抗VEGF药物治疗，33.3%患者更换抗VEGF药物后视力改善，5例（23.8%）联合PDT治疗后视力与单纯抗VEGF治疗相比，差异无统计学意义（P>0.05）。结论　高龄及基线视力差是抗VEGF治疗无效的独立影响因素，部分治疗无效患者更换治疗药物后可改善视力预后。

Factors and outcomes associated with failure to anti-VEGF treatment in patients with wet age-related macular degeneration

Objective　To identify factors associated with ineffectiveness to anti-vascular endothelial growth factor (VEGF) treatment in patients with wet age-related macular degeneration (wAMD) and outcomes of patients with failure to treatment.Methods　This retrospective study included 97 patients who received monthly anti-VEGF treatment for 3 months for wAMD. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated throughout the treatment period. Patients were divided into ineffective group and effective group depending on the effectiveness 1 month after treatment with three loading injections of anti-VEGF agent．The risk factors of ineffective anti-VEGF treatment in WAMD patients by univariate analysis, and the independent risk factors associated with treatment failure were determined with multivariate stepwise logistic regression analysis. Finally, we analyzed the follow-up treatment and outcomes of patients with failure to treatment.Results　The mean logMAR BCVA significantly improved from baseline to follow-up (all P<0.05), and there were significant reductions of CMT compared with the baseline (all P<0.05) 1 month, 2 months, 3 months and the last follow up after anti-VEGF treatment. One month after three loading injections of anti-VEGF agent, 21 patients were classified as ineffective group and 76 patients were classified as effective group. In multivariate analysis, age (OR=2.132，95%CI=2.314-44.342，P=0.011) and baseline BCVA (OR=8.361，95%CI=7.239-32.764，P=0.009) were independent predictors for ineffectiveness. In 12 eyes (57.1%) of the ineffective group received a change of the anti-VEGF agent, and only 33.3% eyes showed an increase of visual acuity thereafter; 5 eyes (23.8%) of ineffective group were subsequently treated with photodynamic therapy (PDT) in combination with anti-VEGF injections, but visual acuity was not improved compared with patients treated with only anti-VEGF injections.Conclusion　Independent predictors for ineffectiveness were age and lower baseline visual acuity. Change of the anti-VEGF agent was effective for part of eyes of non-responders.