不同抗VEGF治疗方式对nAMD患者视网膜下纤维化瘢痕及视力预后的影响

Effect of Different Anti-VEGF Therapy on Subretinal Fibrosis Scar and Visual Prognosis in nAMD Patients

摘要: 目的：探讨不同抗血管内皮生长因子(VEGF)治疗方式对新生血管性年龄相关性黄斑变性(nAMD)患者视网膜下纤维化瘢痕及视力预后的影响。方法：回顾性收集2019年6月至2022年12月于我院眼科就诊并确诊为nAMD的94例患者(共94眼)。按治疗方式不同将患者分为2组，连续3月每月1次后按需(Prn)进行玻璃体腔注射抗VEGF药物组(3 Prn组，65眼)，未规律进行玻璃体腔注射抗VEGF药物治疗组(未完成3 Prn组，29眼)，分析两组患者年龄、性别、手术前后最佳矫正视力(BCVA)、病灶位置等资料，同时收集手术前后光学相干断层扫描(OCT)检查中视网膜纤维化瘢痕宽度及高度数据，分析不同治疗方式下nAMD患者视网膜下纤维化瘢痕及视力是否发生变化。通过对比各组患者基线与终点视网膜下纤维化瘢痕宽度及高度数据和视力变化情况，评价不同治疗方式对患者视网膜下纤维化瘢痕及视力的影响。结果：与治疗前相比，3 Prn组患者终点视网膜下纤维化瘢痕宽度(P = 0.007)、高度(P = 0.042)和未完成3 Prn组患者终点视网膜下纤维化瘢痕宽度(P = 0.013)、高度(P = 0.021)均较基线值升高。未完成3 Prn组患者终点纤维化瘢痕宽度(P < 0.001)、高度(P = 0.037)及宽度变化值(P = 0.042)均大于3 Prn组。治疗后3 Prn组患者BCVA较基线值提高(P < 0.001)，且治疗后3 Prn组较未完成3 Prn组BCVA值高(P = 0.037)。结论：3 Prn给药方式与不规律抗VEGF治疗相比能延缓nAMD患者视网膜下纤维化瘢痕的发展，并且患者能获得更好的视力预后。

Abstract: Objective: To investigate the effects of different anti-vascular endothelial growth factor (VEGF) treatments on subretinal fibrosis scar and visual prognosis in patients with neovascular age-related macular degeneration (nAMD). Methods: A total of 94 patients (94 eyes) diagnosed with nAMD were collected retrospectively from June 2019 to December 2022. Patients were divided into 2 groups according to different treatment methods. The group receiving intravitreal anti-VEGF drug injection as needed (3 Prn group, 65 eyes) once a month for 3 consecutive months, and the group receiving intravitreal anti-VEGF drug injection regularly (failed to complete 3 Prn group, 29 eyes). Age, gender, best corrected visual acuity (BCVA) before and after surgery, and lesion location data of the two groups of patients were analyzed. At the same time, the width and height of retinal fibrosis scar examined by optical coherence tomography (OCT) before and after surgery were collected, and the changes in subretinal fibrosis scar and visual acuity of nAMD patients under different treatment methods were analyzed. By comparing the width, height and visual acuity of subretinal fibrotic scar between baseline and end point in each group, the effects of different treatment methods on subretinal fibrotic scar and visual acuity were evaluated. Results: Compared with before treatment, the end points of subretinal fibrotic scar width (P = 0.007) and height (P = 0.042) in the 3 Prn group and the end points of subretinal fibrotic scar width (P = 0.013) and height (P = 0.021) in the non-completed 3 Prn group were higher than baseline values. The end points of fibrotic scar width (P < 0.001), height (P = 0.037) and width change (P = 0.042) in patients who did not complete 3 Prn were greater than those in 3 Prn group. After treatment, BCVA in the 3 Prn group was higher than baseline (P < 0.001), and BCVA in the 3 Prn group was higher than that in the group that did not complete 3 Prn (P = 0.037). Conclusion: Compared with irregular anti-VEGF therapy, 3 Prn administration can delay the development of subretinal fibrosis scar in nAMD patients, and patients can obtain a better visual prognosis.