玻璃体内抗vegf治疗下糖尿病黄斑病变患者的治疗终止

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-06-02 DOI:10.1016/j.xops.2025.100838

Lucia Saucedo PhD , Isabel B. Pfister PhD , Christin Schild PhD , Justus G. Garweg MD, PhD

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引用次数: 0

摘要

目的评价糖尿病性黄斑水肿（DME）患者因病情稳定而停止治疗的疗效。设计一个单中心、回顾性、连续的病例系列。受试者：2012年至2021年间首次接受抗vegf治疗的DME患者，Snellen最佳矫正视力(VA)≥0.1，随访≥24个月。方法从患者病历中收集基线特征、最佳校正的VA、OCT生物标志物和注射细节。治疗中断定义为在最后一次注射后因任何原因无治疗间隔≥25周。由于视网膜情况稳定而主动决定中断治疗被定义为停止治疗。数据以平均值±标准差表示。主要观察指标：患者停止治疗的百分比，停止治疗和再摄取的时间，以及最佳矫正后的视网膜厚度和视网膜中央厚度的变化。结果109只眼治疗≥24个月，81只眼（62例）符合纳入标准。在5.5±2.3（中位5）年的随访期间，患者接受了22.6±14.9（中位20）次玻璃体内注射，其中第一年接受了7.7±3.0（8.0）次注射。57只眼（70.4%）经历≥1次计划治疗停止≥25周，而4只眼经历计划外治疗中断。53只眼（65.4%）在治疗开始后（106.2±110.4（中位54）周）（65.2±52.4（中位42）周）停止治疗。停止治疗的原因为1眼患者驱动(1.9%；患者不顾医嘱希望停止治疗)，医生驱动38眼（71.7%）；稳定的VA，尽管在OCT中持续残留视网膜液)和OCT驱动的14只眼(26.4%；OCT未见视网膜积液)。基线参数在停止治疗的眼睛和没有停止治疗的眼睛之间具有可比性。结论DME患者经1年强化治疗后，70%的患者治疗停止。这就需要讨论一种可能的系统评估疾病稳定性的方法，即通过在具有稳定残余视网膜液的眼睛中省略单次注射。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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Treatment Cessation in Patients with Diabetic Maculopathy under Intravitreal Anti-VEGF Therapy Following a Treat-and-Extend Protocol

Objective

To assess the outcomes of treatment cessation due to disease stability in eyes with diabetic macular edema (DME).

Design

A single-center, retrospective, consecutive case series.

Subjects

Patients with DME who had received their first anti-VEGF treatment between 2012 and 2021, a Snellen best-corrected visual acuity (VA) ≥0.1, and a follow-up of ≥24 months.

Methods

Baseline characteristics, best-corrected VA, OCT biomarkers over time, and injection details were collected from patients' medical records. Treatment interruption was defined as a treatment-free interval of ≥25 weeks after the last injection for any reason. An active decision for treatment interruption due to a stable retinal situation was defined as treatment cessation. Data are presented as mean ± standard deviation.

Main Outcome Measures

Percentage of patients experiencing treatment cessation, time to treatment cessation and to reuptake, and change in best-corrected VA and central retinal thickness.

Results

Beyond 109 eyes treated over ≥24 months, 81 eyes (62 patients) met the inclusion criteria. During a follow-up of 5.5 ± 2.3 (median 5) years, patients received 22.6 ± 14.9 (median 20) intravitreal injections, 7.7 ± 3.0 (8.0) of these in the first year. Fifty-seven eyes (70.4%) experienced ≥1 planned treatment cessation of ≥25 weeks, while 4 eyes experienced an unplanned treatment interruption. Treatment cessation was documented in 53 eyes (65.4%) 65.2 ± 52.4 (median 42) weeks after treatment initiation for 106.2 ± 110.4 (median 54) weeks. The reason for treatment cessation was patient-driven in 1 eye (1.9%; the patient wished to stop treatment against medical advice), physician-driven in 38 eyes (71.7%; stable VA, despite persisting residual retinal fluid in OCT), and OCT-driven in 14 eyes (26.4%; no retinal fluid in OCT). Baseline parameters were comparable between eyes experiencing treatment cessation and those which did not.

Conclusions

Treatment cessation was achieved in 70% of eyes with DME after intensive treatment during the first year. This calls for a discussion about a possible systematic assessment of disease stability by omitting a single injection in eyes with stable residual retinal fluid.