Long-Term Changes in Submacular Choroidal Thickness after Intravitreal Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration: 14-Mo Follow-Up

<b>Purpose</b>: To study (i) the long-term effects of intravitreal ranibizumab treatment on changes in submacular choroidal thickness and (ii) the relationship between any resulting changes in choroidal thickness and visual outcomes following such treatment in patients with neovascular age-related macular degeneration (n-AMD). <b>Methods</b>: Reviewed were medical records of 30 consecutive, treatment-naïve, patients with unilateral n-AMD (n = 30 eyes) and unaffected fellow eyes (n = 26 eyes) (controls). Monthly injections of 0.5 mg ranibizumab were administered until stabilization of n-AMD, with additional injections as needed over the following 14-mo. Choroidal thickness was determined using enhanced-depth imaging–optical coherence tomography (EDI–OCT) before and after initiation of ranibizumab therapy. Choroidal thickness measurements were generated via manual segmentation. <b>Results</b>: The mean age of patients was 71.9 ± 7.4 (56–83) years; the mean best-corrected visual acuity (BCVA) of affected eyes improved from 51.1 to 59.4 letters (<i>p</i> &lt; 0.001); and the mean number of injections was 9.16 ± 1.75. Subfoveal choroidal thickness decreased from 208.3 ± 73.7 μm at baseline to 185.3 ± 70.1 μm at mo-14 (<i>p</i> &lt; 0.001), with significant (<i>p</i> &lt; 0.001) decreases at all measured time points. Choroidal thickness also tended to decline in fellow eyes but was only statistically significant nasally 1,000 μm (<i>p =</i>0.04). Mean changes in choroidal thickness did not correlate with BCVA at mo-14 (<i>p</i> = 0.76). Disciform scars and geographic atrophy (<i>p =</i> 0.017), and BCVA (<i>p</i> &lt; 001) at baseline were predictive of visual outcome. Age (<i>p =</i> 0.001), reticular drusen (<i>p =</i> 0.004), and size of choroidal neovascularized area (<i>p</i> = 0.042) were predictive of decreases in choroidal thickness. <b>Conclusions</b>: Submacular choroidal thickness appeared to decrease significantly in eyes with n-AMD over a 14-mo period of ranibizumab treatment. No corresponding decrease in choroidal thickness occurred in fellow eyes.

### 研究目的
本研究旨在：（i）探究玻璃体内雷珠单抗（intravitreal ranibizumab）治疗对新生血管性年龄相关性黄斑变性（neovascular age-related macular degeneration, n-AMD）患者黄斑下脉络膜厚度变化的长期影响；（ii）分析该治疗后脉络膜厚度的相关变化与患者视觉预后的关联。

### 研究方法
本研究回顾性分析了30例连续入组的初治单侧n-AMD患者的临床病历资料，共纳入30只患眼，以及其26只健侧未受累眼作为对照。患者接受每月1次0.5mg雷珠单抗玻璃体腔注射，直至n-AMD病情稳定，后续14个月内按需追加注射。在雷珠单抗治疗启动前后，采用增强深度成像光学相干断层扫描（enhanced-depth imaging–optical coherence tomography, EDI–OCT）检测脉络膜厚度，测量值通过手动分割算法获取。

### 研究结果
患者平均年龄为71.9±7.4岁（年龄范围56~83岁）；患眼的平均最佳矫正视力（best-corrected visual acuity, BCVA）从基线的51.1个字母提升至59.4个字母（p<0.001）；平均注射次数为9.16±1.75次。黄斑下脉络膜厚度从基线时的208.3±73.7μm降至第14个月时的185.3±70.1μm（p<0.001），所有检测时间点的厚度均出现显著下降（p<0.001）。健侧眼的脉络膜厚度也呈下降趋势，但仅在鼻侧1000μm位点具有统计学意义（p=0.04）。第14个月时的脉络膜厚度平均变化量与BCVA无显著相关性（p=0.76）。基线时的盘状瘢痕与地图样萎缩（p=0.017）以及BCVA（p<0.001）可有效预测患者的视觉预后。年龄（p=0.001）、网状玻璃膜疣（p=0.004）以及脉络膜新生血管面积（p=0.042）可预测脉络膜厚度的下降幅度。

### 研究结论
接受14个月雷珠单抗治疗的n-AMD患眼，其黄斑下脉络膜厚度出现显著下降；而健侧眼未出现相应的脉络膜厚度降低。