濕性老年性黃斑部病變病人經由癌思停®轉換成樂舒晴®治療後的效果

Outcomes after shifting Bevacizumab to Ranibizumab in patients with wet age–related macular degeneration

莊智鈞(Chih-Chun Chuang)

指導教授 ： 黃建寧

中山醫學大學/醫學院/醫學研究所/碩士(2015年)

摘要

研究目的：藉由觀察同一群濕性老年性黃斑部病變病人的視力以及中心黃斑厚度，比較之前使用玻璃體內注射Bevacizumab癌思停®治療後，轉換成玻璃體內注射Ranibizumab樂舒晴®治療的效果。
研究方法及資料：本篇是一回朔性病例研究，在彰化基督教醫院，自西元2006年9月至西元2012年12月，收錄對象為五十歲以上、經由眼底視網膜檢查、頻域光學同調斷層掃瞄 (SD-OCT)、螢光血管攝影檢查確診為濕性老年性黃斑部病變的病人，其必須接受過至少兩次的玻璃體內注射Bevacizumab癌思停®之後再轉換為接受連續三次的玻璃體內注射Ranibizumab樂舒晴®治療，總共收錄有41位 (45個眼睛)濕性老年性黃斑部病變的病人。預後包括比較病人轉換前後的視力、中心黃斑厚度及判讀頻域光學同調斷層掃瞄 (SD-OCT)。
研究結果：比較在最後一次玻璃體內注射Bevacizumab癌思停®後的平均視力以及在每次玻璃體內注射Ranibizumab樂舒晴®後的平均視力並無統計學上的差異。比較在最後一次玻璃體內注射Bevacizumab癌思停®後的平均中心黃斑厚度以及在每次玻璃體內注射Ranibizumab樂舒晴®後的平均中心黃斑厚度有統計學上的差異。視網膜黃斑部頻域光學同調斷層掃瞄(SD-OCT)圖形分析發現在打完第一次玻璃體內注射Ranibizumab樂舒晴®後有24.3%視網膜內積液能改善，29.7%的視網膜下積液能有改善，37.8%的視網膜色素上皮細胞層分離能有改善。
結論與建議：在濕性老年性黃斑部病變的病人玻璃體內注射Bevacizumab癌思停®後轉換為玻璃體內注射樂舒晴®後，視力維持穩定，但Ranibizumab樂舒晴®可以更減少中心黃斑厚度讓病情更穩定。

關鍵字

濕性老年性黃斑部病變 ； 脈絡膜新生血管 ； 癌思停 ； 樂舒晴

並列摘要

Objective：The objective of this study is to compare visual acuity and central retinal thickness in patients initially treated with bevacizumab (Avastin) and switched to ranibizumab (Lucentis) for neovascular age-related macular degeneration (AMD).
Methods and Materials： A retrospective chart review. This study included 45 eyes from 41 patients with neovascular AMD in Changhua Christian Hospital since September 2006 to December 2012. Patients were initially treated with bevacizumab injections at least 2 times and then switched to ranibizumab for 3 times when it became publicly funded by the Taiwan government. Outcomes include comparison of visual acuity and central retinal thickness after bevacizumab switching to ranibizumab.
Results：After switching to three subsequent intravitreal ranibizumab, the mean logMAR after each ranibizumab was 0.78, 0.81, and 0.77, which was not statistically different from the logMAR obtained after receiving bevacizumab. Mean central retinal thickness as measured by optical coherence tomography significantly decreased after a subsequent course of ranibizumab (p <0.05). After receiving the first time ranibizumab, 24.3% intraretinal fluid, 29.7% subretinal fluid, and 37.8% retinal pigment epithelial detachment observed by optical coherence tomography improved.
Conclusion and Suggestion：After bevacizumab switched to ranibizumab in patients with neovascular AMD, visual acuity kept stable and there was a significant improvement in central retinal thickness. It appears that ranibizumab can maintain, and even improve the effect achieved after an initial course of bevacizumab.

並列關鍵字

age-related macular degeneration ； choroidal neovascularization ； bevacizumab (avastin) ； ranibizumab (lucentis)

參考文獻

1.Bressler, N.M., Age-related macular degeneration is the leading cause of blindness. JAMA, 2004. 291(15): p. 1900-1.

3.Ferris, F.L., 3rd, S.L. Fine, and L. Hyman, Age-related macular degeneration and blindness due to neovascular maculopathy. Arch Ophthalmol, 1984. 102(11): p. 1640-2.

4.Chen, S.J., et al., Prevalence and associated risk factors of age-related macular degeneration in an elderly Chinese population in Taiwan: the Shihpai Eye Study. Invest Ophthalmol Vis Sci, 2008. 49(7): p. 3126-33.

5.Virgili, G. and A. Bini, Laser photocoagulation for neovascular age-related macular degeneration. Cochrane Database Syst Rev, 2007(3): p. CD004763.

6.Bressler, N.M., et al., Verteporfin therapy for subfoveal choroidal neovascularization in age-related macular degeneration: four-year results of an open-label extension of 2 randomized clinical trials: TAP Report No. 7. Arch Ophthalmol, 2005. 123(9): p. 1283-5.