Submacular Hemorrhage Rates Following Anti-Vascular Endothelial Growth Factor Injections for Exudative Age-Related Macular Degeneration

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-10-23 DOI:10.1016/j.ajo.2024.10.017

Gabriel T. Kaufmann , Nicholas Boucher , Chakshu Sharma , Nitika Aggarwal , Matthew R. Starr

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引用次数: 0

Abstract

Purpose

To examine rates of submacular hemorrhage in patients undergoing anti-vascular endothelial growth factor (VEGF) injections, comparing rates between specific anti-VEGF agents.

Design

Retrospective clinical cohort study.

Methods

All patients in the database from January 2015 to November 2023 with a diagnosis of neovascular age-related macular degeneration and accompanying submacular hemorrhage (SMH). SMH prevalence and associated anti-VEGF injection type were analyzed in 140,915 eyes (of which 9107 had SMH) in a nationwide aggregated electronic health care database using chi-square test of proportion. Visual acuity (VA) data was assessed using 2-sample independent t-tests. The primary outcome was rate of SMH per injection type. Secondary datapoints examined were time between SMH diagnosis and last anti-VEGF injection, number of injections before SMH, treatment interval at time of SMH, VA before and at 12 months after SMH, eyes undergoing pars plana vitrectomy (PPV) within 30 days of SMH, and VA before PPV and at 12 months after PPV.

Results

The last injection type in eyes with SMH was bevacizumab in 3430 (37.8%) eyes, brolucizumab-dbll in 46 (0.51%) eyes, aflibercept in 3221 (35.4%) eyes. Ranibizumab in 2246 (24.7%) eyes, and faricimab-svoa in 155 (1.7%) eyes. Rates of SMH were significantly higher (P ≤ .001) for last injection with bevacizumab compared to every other injection type. Rates of SMH were significantly lower (P = .0004) for last injection with faricimab-svoa or ranibizumab injections each had significantly shorter (mean and standard deviation 48.9 (27.9), P < .02; mean and standard deviation 59.6 (38.2), P = .003, respectively) mean time between SMH diagnosis and last injection than did patients undergoing any other injection. Mean VA before SMH and at 12 months after SMH did not significantly differ by injection type among all patients. The number of patients who underwent PPV were 52 (1.51%) for bevacizumab, 4 (8.7%) for brolucizumab-dbll, 58 (1.8%) for aflibercept, 41 (1.8%) for ranibizumab, and 3 (1.9%) for faricimab-svoa. Mean VA before SMH and at 12 months after SMH did not significantly differ by injection type in patients undergoing PPV.

Conclusions

Faricimab may be more protective than other anti-VEGF injections against SMH in patients with neovascular age-related macular degeneration.

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注射抗血管内皮生长因子治疗渗出性老年性黄斑变性后的黄斑下出血率。

目的研究接受抗血管内皮生长因子注射的患者中黄斑下出血的发生率，并比较特定抗血管内皮生长因子药物的发生率：回顾性临床队列研究：2015年1月至2023年11月期间数据库中所有诊断为新生血管性年龄相关性黄斑变性（nAMD）并伴有黄斑下出血（SMH）的患者：采用秩方比例检验法分析了全国范围内汇总的电子医疗数据库中 140,915 只眼睛（其中 9,107 只患有 SMH）的 SMH 患病率和相关的抗血管内皮生长因子注射类型。视力（VA）数据采用双样本独立 t 检验进行评估。主要结果是每种注射类型的 SMH 发生率。检查的次要数据点包括：SMH诊断与最后一次抗VEGF注射之间的时间、SMH前的注射次数、SMH时的治疗间隔、SMH前和SMH后12个月的视力、SMH后30天内接受玻璃体旁切除术（PPV）的眼睛、PPV前和PPV后12个月的视力：结果显示：3439（37.8%）只眼出现SMH，46（0.51%）只眼最后注射贝伐单抗；46（0.51%）只眼最后注射brolucizumab-dbII；3221（35.4%）只眼最后注射aflibercept；2246（24.7%）只眼最后注射ranibizumab；155（1.7%）只眼最后注射faricimab-svoa。与其他所有注射类型相比，最后一次注射贝伐珠单抗的 SMH 发生率明显更高（p≤0.001）。与其他所有注射类型相比，最后一次注射法替单抗-svoa的SMH发生率明显较低（p=0.0004）。接受法尼单抗-svoa或雷尼珠单抗注射的患者，每种注射的时间都明显较短（平均值和标准差（SD）为48.9（27.9），p=0.0004）：与其他抗血管内皮生长因子注射剂相比，法利单抗可能对nAMD患者的SMH具有更强的保护作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.