Abstract：
BACKGROUND: The purpose of this study is to identify the factors affecting neovascular age-related macular degeneration (nAMD) disease stability after brolucizumab treatment.
METHODS: We retrospectively analyzed the medical records of 31 patients (31 eyes) with recalcitrant nAMD who were switched to brolucizumab after conventional anti-vascular endothelial growth factor (VEGF) treatment. We divided patients into two groups by treatment extension (TE) period: group 1 with TE < 12 weeks (N = 16) and group 2 with TE ≥ 12 weeks (N = 15). We compared outcomes between the groups at 2, 4, 8, and 12 weeks, including morphological characteristics of choroidal neovascularization (CNV). Logistic regression analysis identified factors associated with TE ≥ 12 weeks.
RESULTS: Group 2 had a significantly greater proportion of patients with dry macula (subretinal and intraretinal fluids absent) than group 1 (60 vs. 12.5%) at 2 weeks (P < 0.05). Best-corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT) did not differ significantly between groups at all timepoints. Central subfield retinal thickness (CST) was significantly lower in group 2 at 2 (237.1 vs. 280.8 μm; P < 0.05), 4 (224.0 vs. 262.9 μm; P < 0.05), and 8 weeks (216.8 vs. 331.1 μm; P < 0.05). Group 2 had less vessel area (0.63 vs. 1.27 mm2; P < 0.05) and total vessel length (0.22 vs. 0.42 mm; P < 0.05). Choriocapillaris flow deficit (CCFd) was significantly lower in group 2 (42.7 vs. 48.2%; P < 0.05). Dry macula at 2 weeks (odds ratio [OR] = 8.3; P < 0.05) and a lower CCFd (OR = 0.73; P < 0.05) were associated with TE ≥ 12 weeks.
CONCLUSIONS: Early fluid-free status after switching to brolucizumab and choriocapillary function around CNV were prognostic factors for disease stability in nAMD refractory to anti-VEGF treatment.
METHODS: We retrospectively analyzed the medical records of 31 patients (31 eyes) with recalcitrant nAMD who were switched to brolucizumab after conventional anti-vascular endothelial growth factor (VEGF) treatment. We divided patients into two groups by treatment extension (TE) period: group 1 with TE < 12 weeks (N = 16) and group 2 with TE ≥ 12 weeks (N = 15). We compared outcomes between the groups at 2, 4, 8, and 12 weeks, including morphological characteristics of choroidal neovascularization (CNV). Logistic regression analysis identified factors associated with TE ≥ 12 weeks.
RESULTS: Group 2 had a significantly greater proportion of patients with dry macula (subretinal and intraretinal fluids absent) than group 1 (60 vs. 12.5%) at 2 weeks (P < 0.05). Best-corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT) did not differ significantly between groups at all timepoints. Central subfield retinal thickness (CST) was significantly lower in group 2 at 2 (237.1 vs. 280.8 μm; P < 0.05), 4 (224.0 vs. 262.9 μm; P < 0.05), and 8 weeks (216.8 vs. 331.1 μm; P < 0.05). Group 2 had less vessel area (0.63 vs. 1.27 mm2; P < 0.05) and total vessel length (0.22 vs. 0.42 mm; P < 0.05). Choriocapillaris flow deficit (CCFd) was significantly lower in group 2 (42.7 vs. 48.2%; P < 0.05). Dry macula at 2 weeks (odds ratio [OR] = 8.3; P < 0.05) and a lower CCFd (OR = 0.73; P < 0.05) were associated with TE ≥ 12 weeks.
CONCLUSIONS: Early fluid-free status after switching to brolucizumab and choriocapillary function around CNV were prognostic factors for disease stability in nAMD refractory to anti-VEGF treatment.
摘要：
背景：本研究的目的是确定布鲁单抗治疗后影响新生血管性年龄相关性黄斑变性（nAMD）疾病稳定性的因素。
方法：我们回顾性分析了31例（31只眼）顽固性nAMD患者的病历，这些患者在常规抗血管内皮生长因子（VEGF）治疗后改用了溴卢珠单抗。我们根据治疗延长期（TE）将患者分为两组：第1组TE<12周（N=16）和第2组TE≥12周（N=15）。我们在第2、4、8和12周比较了两组之间的结果，包括脉络膜新生血管（CNV）的形态特征。Logistic回归分析确定了与TE≥12周相关的因素。
结果：第2组的干性黄斑（视网膜下液和视网膜内液缺失）患者比例明显高于第1组（60vs.12.5％）在2周（P<0.05）。最佳矫正视力（BCVA）和中央凹下脉络膜厚度（SFCT）在所有时间点两组之间没有显着差异。第2组的中央视野下视网膜厚度（CST）显着降低（237.1vs.280.8μm;P<0.05),4（224.0vs.262.9μm;P<0.05),和8周（216.8vs.331.1μm;P<0.05)。第2组的血管面积较小（0.63vs.1.27mm2；P<0.05）和血管总长度（0.22vs.0.42mm;P<0.05)。第2组的脉络膜毛细血管流量不足（CCFd）显着降低（42.7vs.48.2%;P<0.05)。2周时黄斑干燥（比值比[OR]=8.3；P<0.05）和较低的CCFd（OR=0.73；P<0.05）与TE≥12周相关。
结论：转用Brolucizumab后的早期无液状态和CNV周围的脉络膜毛细血管功能是抗VEGF治疗难治性nAMD疾病稳定性的预后因素。
方法：我们回顾性分析了31例（31只眼）顽固性nAMD患者的病历，这些患者在常规抗血管内皮生长因子（VEGF）治疗后改用了溴卢珠单抗。我们根据治疗延长期（TE）将患者分为两组：第1组TE<12周（N=16）和第2组TE≥12周（N=15）。我们在第2、4、8和12周比较了两组之间的结果，包括脉络膜新生血管（CNV）的形态特征。Logistic回归分析确定了与TE≥12周相关的因素。
结果：第2组的干性黄斑（视网膜下液和视网膜内液缺失）患者比例明显高于第1组（60vs.12.5％）在2周（P<0.05）。最佳矫正视力（BCVA）和中央凹下脉络膜厚度（SFCT）在所有时间点两组之间没有显着差异。第2组的中央视野下视网膜厚度（CST）显着降低（237.1vs.280.8μm;P<0.05),4（224.0vs.262.9μm;P<0.05),和8周（216.8vs.331.1μm;P<0.05)。第2组的血管面积较小（0.63vs.1.27mm2；P<0.05）和血管总长度（0.22vs.0.42mm;P<0.05)。第2组的脉络膜毛细血管流量不足（CCFd）显着降低（42.7vs.48.2%;P<0.05)。2周时黄斑干燥（比值比[OR]=8.3；P<0.05）和较低的CCFd（OR=0.73；P<0.05）与TE≥12周相关。
结论：转用Brolucizumab后的早期无液状态和CNV周围的脉络膜毛细血管功能是抗VEGF治疗难治性nAMD疾病稳定性的预后因素。
