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论文范文
1. Introduction In developed countries, age-related macular degeneration (AMD) is the leading cause of visual loss in individuals over 55 years of age [1]. While representing only 10–20% of AMD cases, the neovascular subtype (nAMD) accounts for 80–90% of severe vision loss in AMD [1]. The visual prognosis of nAMD was dramatically improved by the introduction of antivascular endothelial growth factor (anti-VEGF) agents into clinical practice. The natural history of nAMD is characterized by relatively rapid and inexorably progressive visual loss, with almost 50% of patients losing at least three lines of vision over two years [2]. In contrast, about 80% of patients under monthly ranibizumab treatment avoid visual loss (of >0 early treatment diabetic retinopathy study (ETDRS) letters) over the same time period [3]. Although the overall effectiveness of anti-VEGF therapy is unquestionable, however, there is individual variability in clinical response. While, on average, visual outcomes were excellent in the ANCHOR [3] and MARINA [2] trials, with a mean increase of 11 and 7 ETDRS letters, respectively, after two years of monthly ranibizumab treatment, 10% of patients still lost at least three lines of vision despite adequate treatment [2, 3]. Additionally, those who improved did not all benefit in the same manner; indeed, 33–41% were particularly sensitive to treatment, showing an impressive gain of three or more lines of vision at two years [2, 3]. Being able to predict the individual response to anti-VEGF therapy could be important for several reasons: (1) it might allow ophthalmologists and their patients to adjust their expectations for visual outcomes; (2) it might help optimize treatment, by enabling, for example, the identification of patients who require more frequent anti-VEGF injections or complementary treatments; (3) it might further expand our knowledge on the pathogenesis of nAMD, leading to the development of alternative or complementary treatment strategies. In our study, we aimed to identify predictive factors of visual outcomes, at one and five years of follow-up, in nAMD patients treated with anti-VEGF agents. 2. Methods 2.1. Clinical Setting This was a retrospective study performed at the Department of Ophthalmology of Centro Hospitalar de São João, Porto, Portugal. The study complies with the ethical principles set by the Declaration of Helsinki, and approval for it was obtained from the Ethics Committee of the hospital and of the associated Faculty of Medicine of the University of Porto. 2.2. Selection of Participants We included all patients with nAMD, who began anti-VEGF treatment at our center before October 2009 and who had at least five years of continuous follow-up. Anti-VEGF treatment could include bevacizumab, ranibizumab, and/or aflibercept. Patients were excluded whenever best-corrected visual acuity (BCVA) at diagnosis was inferior to 10 ETDRS letters or whenever the study eye had received photodynamic therapy prior to or concomitantly with anti-VEGF injections. Only one eye of each patient was selected: if both eyes fulfilled the selection criteria, we arbitrarily selected the right one. In all cases, the diagnosis of nAMD was based on funduscopic examination, optical coherence tomography (OCT), and fluorescein angiography, which were routinely performed at baseline. 
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