光动力与Bevacizumab联合治疗湿性年龄相关性黄斑变性比较

Photodynamic therapy versus primary and secondary intravitreal bevacizumab in neovascular age-related macular degeneration

目的 比较光动力疗法（PDT）、玻璃体内注射Bevacizumab（IVB）及二者联合在治疗湿性年龄相关性黄斑变性（AMD）中的疗效.方法 回顾分析1999年10月至2007年9月在澳大利亚西澳大学狮子眼科研究所连续接受治疗的AMD患者.治疗后视力提高、不变或logMAR视力下降3行以内且最后随访视力≥6/60者定义为治疗有效;治疗后logMAR视力下降3行以上或最后随访视力〈6/60者为治疗无效.结果 共有连续672例湿性AMD患者接受了治疗.随访3个月以上（平均23.5月）者503例,其中234例接受了一次或多次PDT治疗;79例在接受一次或多次PDT后续用IVB;190例首选IVB治疗.PDT治疗组25.6%（60/234）、PDT联合IVB组39.2%（31/79）的患者获得有效治疗;而首选IVB治疗组66.8%（127/190）的患者获得有效治疗.与PDT治疗组相比较,首选IVB治疗组和联合治疗组获得有效治疗的校正odds ratio（OR）分别是5.17（95%可信区间=3.10-8.59）和1.71（95%可信区间=0.93-3.13）. CNV类型、大小与疗效无关,而治疗前视力及视网膜瘢痕形成与疗效呈负相关.结论 玻璃体内注射Bevacizumab治疗湿性AMD疗效明显优于PDT或继PDT之后续用Bevacizumab.

Objective To compare the efficacy of photodynamic therapy （PDT） with primary intravitreal bevacizumab （ⅣB） and secondary ⅣB following multiple sessions of PDT in neovascular age-related macular degeneration （AMD）.Methods Consecutive retrospective comparative case series were conducted in neovascular AMD patients treated at the Lions Eye Institute,Western Australia,from October 1999 to September 2007.All patients were monitored monthly and retreated on an＂as needed＂basis.Ophthalmic evaluation included best corrected Snellen visual acuity （VA）,complete ophthalmic examination,fluorescein angiography,or optical coherence tomography.The main outcome measures were changes in Snellen VA with arbitrary definition of treatment efficacy and angiographic lesion characteristics.Results Six hundred and seventy-two patients received treatment;503 patients with at least 3 months （3-94.1 months,mean 23.5 months,median 13.8 months） follow up were included in the analysis.25.6% patients （60 out of 234 patients） benefited from PDT treatment,while 39.2% （31 out of 79 patients ） benefited from secondary ⅣB after PDT and 66.8% （127out of 190 patients） benefited from primary ⅣB.Adjusted odds ratio （OR） of treatment benefit for primary ⅣB and secondary ⅣB following PDT versus PDT alone were 5.17 （95%CI=3.10.8-59） and 1.71 （95%CI=0.93-3.13） respectively;P〈0.001.Pre-treatment VA and subretinal scar tissue were negatively associated with treatment efficacy.No association was found between lesion composition,lesion size and treatment efficacy.Conclusions Primary ⅣB injection is more efficient than secondary injection after multiple sessions of PDT or PDT alone in treating neovascular AMD.