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2021亚太玻璃体视网膜学会新生血管性AMD的治疗和延长方案专家共识解读
孙隽然
孙晓东
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20240818-00234
Interpretation of the 2021 Asia-Pacific Vitreo-Retina Society Expert Consensus on the Treat-and-Extend Protocol for nAMD
Sun Junran
Sun Xiaodong
Authors Info & Affiliations
Sun Junran
Department of Ophthalmology, Shanghai General Hospital, Shanghai 200080, China
Sun Xiaodong
Department of Ophthalmology, Shanghai General Hospital, Shanghai 200080, China
·
DOI： 10.3760/cma.j.cn115989-20240818-00234
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摘要

治疗－延长(T&E)方案是临床常用的抗血管内皮生长因子(VEGF)药物治疗新生血管性年龄相关性黄斑变性(nAMD)方案之一，可以在有效改善视力的同时延长治疗间隔、减少就诊次数。面对亚太地区医疗资源有限、患者治疗依从性不佳，T&E方案具有独特的优势。然而目前亚太地区临床使用抗VEGF药物缺乏规范化的治疗路径，尚缺乏关于T&E方案的指南。2021年亚太玻璃体视网膜学会专家组(APVRS)回顾并总结抗VEGF药物T&E方案临床研究，结合临床实践情况制定一组关于在亚太地区使用T&E方案治疗nAMD的共识。本文就APVRS专家组提出的最新T&E治疗方案进行解读以指导临床医师规范治疗。

新生血管性年龄相关性黄斑变性;血管生成抑制剂;治疗－延长方案;亚太玻璃体视网膜学会专家组;共识解读
ABSTRACT

The treat-and-extend (T&E) protocol for treating neovascular age-related macular degeneration (nAMD) is one of the commonly used anti-vascular endothelial growth factor (VEGF) treatment strategies in clinical practice.It effectively improves vision while extending treatment intervals and reducing the number of clinic visits.In the Asia-Pacific region, where medical resources are limited and patient compliance is often poor, the T&E protocol offers unique advantages.However, there are currently no guidelines on the T&E protocol in this region, and its clinical use lacks standardized treatment pathways.In 2021, the Asia-Pacific Vitreo-Retina Society (APVRS) expert panel reviewed and summarized clinical research on the anti-VEGF T&E protocol, combining this with clinical practice to develop a set of consensus recommendations for using the T&E protocol to treat nAMD in the Asia-Pacific region.This article reviews and interprets the latest T&E treatment protocol proposed by the APVRS expert panel to guide clinicians in standardized treatment.

Wet macular degeneration;Angiogenesis inhibitors;Treat-and-extend regimen;Asia-Pacific Vitreo-Retina Society;Interpretation of expert consensus
Sun Xiaodong, Email: nc.defudabe.utjsnusdx
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引用本文

孙隽然,孙晓东. 2021亚太玻璃体视网膜学会新生血管性AMD的治疗和延长方案专家共识解读[J]. 中华实验眼科杂志,2025,43(01)：9-17.

DOI:10.3760/cma.j.cn115989-20240818-00234

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新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration，nAMD)是全球50岁以上人群主要的致盲性眼病之一。预计2050年全球65岁及以上人口将超过15亿，亚太地区老龄人口的增加仅次于非洲，其中nAMD患者预计将超过3亿人 [ 1 , 2 , 3 , 4 ]。息肉样脉络膜血管病变(polypoidal choroidal vasculopathy，PCV)作为nAMD的一个亚型，多见于亚太人群，在60岁以上患者中占比达1.3%～2.0% [ 5 ]，具有特征性的视网膜下结节性息肉样血管病变，导致复发性出血和浆液性视网膜色素上皮脱离，严重影响患者视力预后及生活质量。
抗血管内皮生长因子(vascular endothelial growth factor，VEGF)治疗是nAMD的一线选择，目前临床上主要采用的抗VEGF给药方案有3种：固定给药方案、3＋按需治疗(pro re nata，PRN)方案、治疗－延长(treat-and-extend，T&E)方案。其中T&E在有效改善视力的同时可以延长治疗间隔、减少就诊次数。临床研究数据显示，相较于3＋PRN方案，T&E方案第1年视力获益平均增加6.18个字母，年平均就诊次数减少0.95～6.12次，目前已经逐渐成为全球临床医师的首选 [ 6 , 7 ]。在亚太地区，多数国家医疗资源有限，许多患者为老年人，需长途跋涉前往治疗中心，加之医疗保险覆盖不全面，治疗成本增加，极大地降低了患者治疗依从性。在中国，尽管智慧医院和互联网医院建设有了很大的突破，但是医疗资源集中、预约就诊流程繁琐客观上还是会影响患者的及时复诊和治疗，导致真实世界中药物疗效远低于临床试验，从而进一步降低患者依从性。大量研究显示nAMD患者治疗效果不佳与依从性差及随访次数少有关 [ 8 ]。因此，推广T&E方案在亚太地区的广泛应用非常重要。
目前亚太地区尚缺少关于T&E方案的指南，临床上仍以3＋PRN方案为主。为了更好地在亚太地区规范化应用T&E方案，2021年亚太玻璃体视网膜学会(Asia-Pacific Vitreo-retina Society，APVRS)系统检索了MEDLINE、EMBASE、Cochrane数据库以及APVRS、欧洲视网膜专家学会年会、美国眼科学年会、世界眼科争鸣大会：亚洲－澳大利亚大会摘要。筛选并纳入了在nAMD患者中使用阿柏西普、雷珠单抗和贝伐单抗评估T&E方案的随机对照试验(randomized controlled trial，RCT)、病例对照研究、队列研究、meta分析及综述共27篇。分析了最佳矫正视力(best corrected visual acuity，BCVA)变化、注射间隔、玻璃体腔注射次数和门诊随访次数。APVRS专家小组(由18名国际视网膜专家组成)召开会议讨论可能影响亚太地区使用T&E方案治疗nAMD和PCV的关键因素，包括药物疗效、安全性、分子特性和视网膜积液类型。最后专家组一致同意并制定了一组关于在亚太地区使用T&E方案治疗nAMD和PCV的共识建议 [ 9 ]。本文将对该共识进行解读，以期提高临床医师对T&E方案的理解，更好地制定nAMD患者治疗随访方案，提高患者视力。
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孙晓东，Email： nc.defudabe.utjsnusdx
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