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.
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。