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Different Factors Associated with 2-Year Outcomes in Patients with Branch versus Central Retinal Vein Occlusion Treated with Ranibizumab.
Ophthalmology ( IF 13.1 ) Pub Date : 2019-07-23 , DOI: 10.1016/j.ophtha.2019.07.018
Raafay Sophie 1 , Pin-Wen Wang 2 , Roomasa Channa 3 , Carlos Quezada-Ruiz 2 , Ann Clark 2 , Peter A Campochiaro 4
Affiliation  

PURPOSE To investigate characteristics associated with visual and anatomic outcomes in branch and central retinal vein occlusion (BRVO and CRVO) patients treated with ranibizumab. DESIGN Post hoc analysis of patients with BRVO and CRVO from 2 multicenter clinical trials who completed month 12 of the HORIZON extension trial. PARTICIPANTS 205 patients with BRVO and 181 patients with CRVO who completed month 12 of the extension trial. METHODS With the use of logistic regression, covariates with a P value < 0.20 from univariate analysis were included in multivariate models to identify independent factors associated with a given outcome (at P < 0.05), with preset variables of disease duration and original treatment assignment. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) ≥20/40 (≥70 letters), gain ≥15 letters, and central subfield thickness (CST) ≤250 μm at HORIZON month 12. RESULTS In patients with BRVO, good baseline BCVA (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.30-1.79), male sex (OR, 2.48; 95% CI, 1.20-5.13), and normal hematocrit (low vs. normal, OR, 0.26; 95% CI, 0.12-0.59) predicted BCVA ≥20/40; high central foveal thickness (OR, 1.03; 95% CI, 1.01-1.04) and normal hematocrit (low vs. normal, OR, 0.31; 95% CI, 0.15-0.66) predicted BCVA improvement ≥15 letters; and extensive baseline subretinal fluid modestly predicted CST ≤250 μm (OR, 1.08; 95% CI, 1.00-1.16). In patients with CRVO, good baseline BCVA (OR, 1.59; 95% CI, 1.35-1.89), never smoking (OR, 2.80; 95% CI, 1.27-6.17), and young age (OR, 0.58; 95% CI, 0.41-0.82) predicted BCVA ≥20/40; never smoking (OR, 2.13; 95% CI, 1.03-4.39), young age (OR, 0.41; 95% CI, 0.28-0.59), poor baseline BCVA (OR, 0.82; 95% CI, 0.73-0.93), hypertension (OR, 4.47; 95% CI, 1.70-11.75), and low diastolic ocular perfusion pressure (OPP) throughout the study (OR, 0.39; 95% CI, 0.21-0.72) predicted BCVA improvement ≥15 letters; and young age (OR, 0.65; 95% CI, 0.47-0.90), lower mean hematocrit (low vs. normal, OR, 2.81; 95% CI, 1.06-7.49), high systolic OPP throughout the study (OR, 1.61; 95% CI, 1.14-2.27), large areas of central hemorrhage (OR, 1.44; 95% CI, 1.04-2.00), and no subretinal fluid (OR, 2.15; 95% CI, 1.06-4.40) predicted CST ≤250 μm. CONCLUSIONS There are substantial differences in good outcome factors in CRVO versus BRVO, suggesting differences in pathophysiology. Young age, never smoking, hemodilution, and hypertension/high systolic perfusion pressure are more beneficial in CRVO, suggesting that avoidance of sluggish blood flow and maintenance of perfusion may be particularly important in CRVO.

中文翻译:

雷尼单抗治疗分支静脉与中央视网膜静脉阻塞的患者2年结局相关的不同因素。

目的研究兰尼单抗治疗的分支和视网膜中央静脉阻塞(BRVO和CRVO)患者的视觉和解剖学结局相关特征。设计对2个完成HORIZON扩展试验第12个月的多中心临床试验的BRVO和CRVO患者进行事后分析。参与者205名BRVO患者和181名CRVO患者完成了扩展试验的第12个月。方法采用逻辑回归,将单变量分析中P值<0.20的协变量纳入多变量模型,以识别与给定结局相关的独立因素(P <0.05),并设置疾病持续时间和原始治疗方案的预设变量。主要观察指标最佳矫正视力(BCVA)≥20/ 40(≥70个字母),增益≥15个字母,结果在HORIZON第12月时,中心子场厚度(CST)≤250μm。结果在BRVO患者中,基线BCVA良好(比值[OR]为1.53; 95%置信区间[CI]为1.30-1.79),男性(OR) ,2.48; 95%CI,1.20-5.13)和正常血细胞比容(相对于正常血红蛋白偏低,OR,0.26; 95%CI,0.12-0.59)预测BCVA≥20/ 40;中心凹中央厚度高(OR,1.03; 95%CI,1.01-1.04)和正常血细胞比容(相对于正常值,OR,低0.31; 95%CI,0.15-0.66)预测BCVA改善≥15个字母;和广泛的基线视网膜下液适度地预测CST≤250μm(OR,1.08; 95%CI,1.00-1.16)。在CRVO患者中,基线BCVA良好(OR,1.59; 95%CI,1.35-1.89),从不吸烟(OR,2.80; 95%CI,1.27-6.17),以及年轻年龄段(OR,0.58; 95%CI, 0.41-0.82)预测BCVA≥20/ 40;永不吸烟(OR,2.13; 95%CI,1.03-4.39),年轻人(OR,0.41; 95%CI,0.28-0.59),在整个研究过程中基线BCVA较差(OR,0.82; 95%CI,0.73-0.93),高血压(OR,4.47; 95%CI,1.70-11.75),舒张期眼灌注压(OPP)低(OR,0.39; 95 %CI,0.21-0.72)预测BCVA改善≥15个字母; 和年轻年龄(OR为0.65; 95%CI为0.47-0.90),平均血细胞比容较低(与正常水平相比较低,OR为2.81; 95%CI为1.06-7.49),整个研究期间的收缩期OPP较高(OR为1.61; 95%CI,1.14-2.27),大面积中央出血(OR,1.44; 95%CI,1.04-2.00),无视网膜下积液(OR,2.15; 95%CI,1.06-4.40)预测CST≤250μm 。结论CRVO与BRVO的良好预后因素存在实质性差异,表明病理生理学方面存在差异。年龄较小,从不吸烟,血液稀释和高血压/高收缩压对CRVO更为有益,
更新日期:2019-07-23
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