Current Smoking Is Associated with a Poor Visual Acuity Improvement after Intravitreal Ranibizumab Therapy in Patients with Exudative Age-Related Macular Degeneration

다국어 초록 (Multilingual Abstract)

In this study, the risk factors that may influence visual improvement after intravitreal ranibizumab (IVR) treatment for exudative age-related macular degeneration (AMD) were examined. From 2008 to 2012, 420 patients (448 eyes) with exudative AMD were prospectively registered at Seoul National University Hospital. From this group of patients,125 eyes were included in this study. All patients were treated with 3 consecutive IVR injections. The visual acuity (VA) was evaluated at baseline and 1 month after the third ranibizumab injection. To evaluate the risk factors associated with VA improvement after IVR, patient demographic data and systemic risk factors were analyzed. Patients were divided into a poor VA improvement group and a good VA improvement group, with reference to the median visual improvement in all eyes. Among 125 eyes, 66 eyes (52.8%)were included in the responder group and 59 eyes (47.2%) in the non-responder group.
The median VA improvement after 3 monthly ranibizumab injections was -0.05 logMAR.
Multivariate analyses revealed that current smoking (adjusted OR, 7.540; 95% CI, 1.732-32.823) was independently associated with poor VA improvement after IVR treatment for exudative AMD. In conclusion, cigarette smoking is an independent risk factor for lower VA gains with IVR treatment for exudative AMD.

참고문헌 (Reference)

1 Wickremasinghe SS, "Variants in the APOE gene are associated with improved outcome after anti-VEGF treatment for neovascular AMD" 52 : 4072-4079, 2011

2 Ni Dhubhghaill SS, "The pathophysiology of cigarette smoking and age-related macular degeneration" 664 : 437-446, 2010

3 "Risk factors for neovascular age-related macular degeneration: the Eye Disease Case-Control Study Group" 110 : 1701-1708, 1992

4 Tomany SC, "Risk factors for incident age-related macular degeneration: pooled findings from 3 continents" 111 : 1280-1287, 2004

5 Age-Related Eye Disease Study Research Group, "Risk factors associated with age-related macular degeneration: a case-control study in the agerelated eye disease study: Age-Related Eye Disease Study Report Number 3" 107 : 2224-2232, 2000

6 Moutray T, "Relationships between clinical measures of visual function, fluorescein angiographic and optical coherence tomography features in patients with subfoveal choroidal neovascularisation" 92 : 361-364, 2008

7 Unver YB, "Relationships between clinical measures of visual function and anatomic changes associated with bevacizumab treatment for choroidal neovascularization in age-related macular degeneration" 23 : 453-460, 2009

8 Kaiser PK, "Ranibizumab for predominantly classic neovascular age-related macular degeneration: subgroup analysis of first-year ANCHOR results" 144 : 850-857, 2007

9 Mitchell P, "Ranibizumab (Lucentis) in neovascular age-related macular degeneration: evidence from clinical trials" 94 : 2-13, 2010

10 Heeschen C, "Nicotine stimulates angiogenesis and promotes tumor growth and atherosclerosis" 7 : 833-839, 2001

11 Suner IJ, "Nicotine increases size and severity of experimental choroidal neovascularization" 45 : 311-317, 2004

12 Conklin BS, "Nicotine and cotinine up-regulate vascular endothelial growth factor expression in endothelial cells" 160 : 413-418, 2002

13 Boyer DS, "MARINA Study Group. Subgroup analysis of the MARINA study of ranibizumab in neovascular age-related macular degeneration" 114 : 246-252, 2007

14 Kliffen M, "Increased expression of angiogenic growth factors in age-related maculopathy" 81 : 154-162, 1997

15 Khan JC, "Genetic Factors in AMD Study. Smoking and age related macular degeneration: the number of pack years of cigarette smoking is a major determinant of risk for both geographic atrophy and choroidal neovascularisation" 90 : 75-80, 2006

16 Friedman DS, "Eye Diseases Prevalence Research Group. Prevalence of age-related macular degeneration in the United States" 122 : 564-572, 2004

17 Nischler C, "Complement factor H Y402H gene polymorphism and response to intravitreal bevacizumab in exudative age-related macular degeneration" 89 : e344-e349, 2011

18 Seddon JM, "Cigarette smoking, fish consumption, omega-3 fatty acid intake, and associations with age-related macular degeneration: the US Twin Study of Age-Related Macular Degeneration" 124 : 995-1001, 2006

19 McKibbin M, "CFH, VEGF and HTRA1 promoter genotype may influence the response to intravitreal ranibizumab therapy for neovascular age-related macular degeneration" 96 : 208-212, 2012

20 Fung AE, "An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration" 143 : 566-583, 2007

21 Vingerling JR, "Age-related macular degeneration is associated with atherosclerosis: the Rotterdam Study" 142 : 404-409, 1995

22 Seddon JM, "A prospective study of cigarette smoking and age-related macular degeneration in women" 276 : 1141-1146, 1996