玻璃体腔注射抗VEGF药物治疗湿性年龄相关性黄斑变性的5年回顾性研究

Intravitreal injection of anti-VEGF agents in wet age-related macular degeneration: a 5-year retrospective study

目的:调查抗VEGF药物治疗湿性年龄相关性黄斑变性(wet age-related macular degeneration,wAMD)5年的疗效。方法:2011年至2021年于北京医院眼科诊断为wAMD的患者共84人103只眼进行回顾性分析。抗VEGF治疗采用3+PRN方案。观察5年来的最佳矫正视力(best-corrected visual acuity,BCVA)、玻璃体腔注射次数、随访次数和病灶的解剖学变化。结果:治疗5年后平均BCVA为38.1个字母,与基线相比下降9.4个字母,差异有统计学意义(P<0.001)。23.3%的患眼5年后可维持初始视力。5年内平均注射次数为13.8次,第1年注射次数最多,平均为4.3次。5年内平均随访次数为24.3次,仅有34.0%的患眼可遵循每次随访间隔≤3个月。5年后有68.0%的患眼出现纤维瘢痕,27.2%的患眼出现地图样萎缩,69.0%(71/103)的患眼存在持续的色素上皮脱离(pigment epithelial detachment,PED)。年龄、基线BCVA、是否初始治疗、随访年限、注射次数、中心视网膜厚度(central retina thickness,CRT)、地图样萎缩等对BCVA有显著影响。结论:多数患者在抗VEGF治疗1年内可维持视力,但5年以上维持效果不佳。早期诊治、提高注射频率,可能是未来改善预后的研究方向。

Objective:To investigate the efficacy of anti-VEGF injection in the treatment of wet age-related macular degeneration(wAMD) for 5 years.Methods:A total of 84 patients(103 eyes) wAMD diagnosed in Department of Ophthalmology in Beijing Hospital from 2011 to 2021 were analyzed retrospectively.3+PRN regimen was applied for anti-VEGF treatment.The changes of best corrected visual acuity(BCVA),the number of intravitreal injections and the number of follow-up visits,and the anatomical changes of the lesions in the past 5 years were collected.Results:The average BCVA after 5 years was 38.1 letters,indicating a decrease of 9.4 letters comparing to baseline,which was statistically significant(P<0.001).23.3% of the eyes could maintain the baseline BCVA after 5 years.The average injection times within 5 years was 13.8,and the injection was concentrated in the first year,with an average of 4.3.The average number of follow-up visits within 5 years was 24.3,and only 34.0% of the affected eyes could keep the follow-up interval ≤3 months.After 5 years,68.0% of the eyes developed fibrous scar,27.2% developed geographic atrophy,and 69.0%(71/103) had consistent pigment epithelial detachment.Factors significantly affect BCVA include:age,baseline BCVA,initial treatment,follow-up time,injection times,central retinal thickness,geographic atrophy and so on.Conclusion:Most patients can maintain vision within the first year after anti-VEGF treatment,but the efficacy is poor for more than 5 years.Early diagnosis and treatment,and increased injection frequency may be the research direction for improving prognosis in the future.