阿柏西普治疗渗出型老年性黄斑变性合并视网膜色素上皮脱离的疗效观察

The effect of aflibercept in the treatment of exudative age-related macular degeneration combined with retinal pigment epithelial detachment

目的观察玻璃体腔注射阿柏西普(IVA)治疗渗出型老年性黄斑变性(wAMD)合并RPE脱离(PED)的疗效。方法回顾性病例研究。2018年6月至2019年6月于解放军中部战区总医院眼科检查确诊的wAMD合并PED患者27例32只眼(整体组)纳入研究。所有患眼均行IVA治疗。起始负荷剂量2.0 mg,每月注射1次,连续2个月,经评估按需给药。根据治疗后2个月PED最大高度(PEDH)将整体组分为应答组、部分应答组,分别为20(62.50%)、12(37.50%)只眼。应答:PEDH较治疗前下降≥25%;部分应答:PEDH下降<25%。采用日本Topcon公司3D-OCT 2000仪对黄斑中心凹进行扫描。测量PEDH、PED面积(PEDA)、PED体积(PEDV)、黄斑中心凹视网膜厚度(CMT)。应答组、部分应答组患眼BCVA、CMT、PEDH、PEDA、PEDV比较,差异均无统计学意义(t=-0.791、-0.488、-0.900、-1.130、-0.400,P=0.435、0.630、0.380、0.270、0.690)。观察治疗前及治疗后1、2、4、6个月各组BCVA、PEDH、PEDA、PEDV、CMT变化。治疗前后BCVA及PED相关指标、CMT比较采用重复测量方差分析。结果与治疗前比较,治疗后不同时间整体组、应答组、部分应答组患眼BCVA、CMT、PEDH、PEDA、PEDV均有不同程度改善。其中,整体组、应答组患眼所有指标差异均有统计学意义(FBCVA=5.871、3.798,P=0.001、0.019;FCMT=24.526、14.109,P=0.000、0.001;FPEDH=12.569、12.091,P=0.000、0.000;FPEDA=7.534、6.286,P=0.000、0.000;FPEDV=5.139、4.104,P=0.004、0.014);部分应答组患眼PED相关指标差异无统计学意义(FPEDH=3.210,P=0.054;FPEDA=1.913,P=0.183;FPEDV=3.500,P=0.051),BCVA、CMT差异有统计学意义(FBCVA=3.033,P=0.027;FCMT=11.140,P=0.001)。治疗后2个月,整体组PEDH下降幅度<25%、25%~<50%、50%~<75%、≥75%者分别为12(37.50%)、8(25.00%)、9(28.13%)、3(9.38%)只眼,其中PED完全消退1只眼(3.13%);治疗后6个月,分别为13(40.23%)、5(15.63%)7(21.88%)、7(21.88%)只眼,其中PED完全消退4只眼(12.50%)。结论阿柏西普治疗wAMD合并PED短期内可恢复其解剖学指标,提高视功能;按需治疗阶段的PED疗效与负荷剂量阶段的疗效有关。

Objective To observe the efficacy of intravitreal injection of aflibercept(IVA)in the treatment of exudative age-related macular degeneration(wAMD)combined with RPE detachment(PED).Methods A retrospective case study.From June 2018 to June 2019,32 eyes(overall group)of 27 wAMD patients with PED were included in the study.All eyes were treated with IVA.The initial loading dose was 2.0 mg,which was injected once a month for 2 consecutive months and and then use a PRN regimen after evaluation.According to the maximum height of PED(PEDH)2 months after treatment,the overall group was divided into the response group and the partial response group,with 20(62.50%)and 12(37.50%)eyes respectively.The response group:PEDH decreased by≥25%compared with before treatment.The partial response:PEDH decreased by<25%.The macular fovea was scanned with the 3D-OCT 2000 instrument from Topcon(Japan).PEDH,PED area(PEDA),PED volume(PEDV),and macular foveal retinal thickness(CMT)were measured.There was no significant difference in BCVA,CMT,PEDH,PEDA,and PEDV of the eyes in the response group and the partial response group(t=-0.791,-0.488,-0.900,-1.130,-0.400;P=0.435,0.630,0.380,0.270,0.690).The changes of BCVA,PEDH,PEDA,PEDV,CMT in each group were observed before treatment and 1,2,4,and 6 months after treatment.The comparison of BCVA and PED-related indicators and CMT before and after treatment were performed by repeated measures analysis of variance.Results Compared with before treatment,the BCVA,CMT,PEDH,PEDA and PEDV of the eyes in the overall group,the response group,and the partial response group were obviously improved after treatment.Among them,there were statistically significant differences in all indicators of the overall group and the response group(FBCVA=5.871,3.798;P=0.001,0.019.FCMT=24.526,14.109;P=0.000,0.001.FPEDH=12.569,12.091;P=0.000,0.000.FPEDA=7.534,6.286;P=0.000,0.000.FPEDV=5.139,4.104;P=0.004,0.014);there was no statistically significant difference in PED-related indicators in the partial response group(FPEDH=3.210,P=0.054;FPEDA=1.913,P=0.183;FPEDV=3.500,P=0.051),the difference between BCVA and CMT was statistically significant(FBCVA=3.033,P=0.027;FCMT=11.140,P=0.001).Two months after treatment,the eye number of PEDH reduction rate<25%,25%-<50%,50%-<75%,and≥75%were 12(37.50%),8(25.00%),9(28.13%),and 3(9.38%)in the overall group,respectively.And PED in one eye(3.13%)was completely eliminated.Six months after treatment,the proportion was 13(40.23%),5(15.63%),7(21.88%)and 7(21.88%),respectively,among which 4 eyes(12.50%)with PED were completely resolved.Conclusions Aflibercept treatment of wAMD combined with PED can restore its anatomical indicators and improve visual function of patients in a short time;the efficacy of PED in the PRN stage is related to the efficacy of the loading dose stage.