外层视网膜管型在nARMD中的发生率及其对抗VEGF治疗注射次数的影响

Prevalence of outer retinal tubulation in nARMD and its influence on anti-VEGF retreatment

目的:探索抗血管内皮生长因子(VEGF)治疗的渗出性年龄相关性黄斑变性(nARMD)患眼中出现外层视网膜管型(ORT)的比例,及ORT出现前后抗VEGF治疗的频率。方法:回顾性分析,共纳入按3+PRN方案治疗的nARMD患者54例60眼,基线时患者进行荧光素眼底血管造影(FFA)、眼底彩照(CFP)、最佳矫正视力(BCVA)及黄斑相干光断层扫描成像(OCT)检查,以后每月随访查BCVA、眼底彩照及黄斑OCT。记录患者OCT上视网膜下高反射物质(SHRM)的比例及随访中出现ORT结构的时间及比例,比较出现ORT前后玻璃体腔注射的平均次数。比较出现ORT眼及未出现ORT眼两组的BCVA及中心视网膜厚度(CRT)。结果:在基线及随访至6、12、24mo时,ORT出现的比例分别为15.0%、21.7%、25.0%及46.7%。出现ORT后抗VEGF每月平均注射次数减少(P<0.05)。基线时有78.3%患眼出现SHRM,其中66.0%最后出现ORT,而在基线时不存在SHRM的13眼中仅23.1%眼出现ORT,相对风险值为2.86(P<0.01)。出现ORT眼较未出现ORT眼的BCVA更差及CRT更厚。结论:ORT随着病程延长逐渐增加,ORT出现后抗VEGF再治疗的频率下降。

·AIM:To explore the prevalence of outer retinal tubulation(ORT)in nAMD patients treated with anti-VEGF and the frequency of anti-VEGF therapy before and after ORT appearance.·METHODS:Sixty eyes of 54 patients were included in the study(treated with ranibizumab by pro re nata regimen(PRN)and followed up for 24mo.At baseline,patients underwent fluorescein fundus angiography(FFA),fundus color photography(CFP),best corrected visual acuity(BCVA)and macular optical coherence tomography(OCT),and followed up monthly thereafter.The subretinal hyper reflective material(SHRM)and ORT was recorded at baseline,and the time of new appearance of outer retinal tubulation structure during followup also was noted.The average number of intravitreal injections before and after ORT was compared.The BCVA and central retinal thickness(CRT)were compared between ORT eyes and non-ORT eyes.·RESULTS:ORT was found in 15.0%,21.7%,25.0%and 46.7%of patients at baseline.After ORT appearance,the average number of injections of anti-VEGF per month decreased(Whitman U test,P=0.006),and the difference was statistically significant.At baseline,78.3%of the eyes had SHRM,66.0%of which eventually had ORT,while at baseline,there was only 23.1%of the eyes had ORT in no SHRM eyes,with a relative risk of 2.86(P<0.01).The BCVA and CRT were worse in ORT eyes than those in non-ORT eyes.·CONCLUSION:ORT increases gradually with the prolongation of the course of the disease,and the frequency of anti-VEGF retreatment decreases after the occurrence of ORT.