Retina Pigment Epitel Dekolmanı Olan Yaşa Bağlı Makula Dejenerasyonu Olgularında Anti-Vegf Tedavinin Etkileri

Abstract

Purpose: To evaluate the effect of anti-VEGF therapy on anatomical and visual results in pigment epithelial detachment (PED) secondary to agerelated macular degeneration (AMD). Materials and Methods: 111 eyes of 106 patients followed in Retina Unit of our clinic, who had PED secondary to AMD, treated with intravitreal bevacizumab, ranibizumab or aflibercept as monotherapy or consecutive therapy was evaluated retrospectively. Best corrected visual acuity (BCVA) evaluated on the ETDRS chart; central macular thickness (CMT), lesion type and width, PED height and width, subtype of PED measured with optical coherence tomography (OCT); number of injections, follow-up duration and number of visits were assessed from patients medical records and imaging system records. Baseline and final findings were evaluated. Results: 59 of the patients were female (55.7%), 47 were male (44.3%). The mean age at diagnosis was 75.4 ± 9.6 (49-77), the mean follow-up duration was 43.3±21.18 (12-84) months and the mean number of visits were 26.9±17.7 (4-101). While the mean baseline BCVA was found 53.26 ± 16.8 (12-88) letters, at the end of the follow-up period it was 35.1±19.63 (10-80) letters. The mean baseline CMT was found 269 ± 93.2 (116-595) microns, at last follow-up was found 245 ± 49 (138-359) microns. Among the whole PEDs, 48 (43%) cases were fibrovascular, 36 (32.5%) were serous, sixteen (14%) were hemorrhagic and 11 (10%) cases were drusenoid. The mean baseline PED height was 440.24±178.56 (134-1021) microns, the mean PED width was 2161±864.103 (1010- 4612) microns and the mean PED height decrease time was found 8.71±8.4 (2-46) months. 62 eyes (55.8%) of 111 eyes were treated with ranibizumab, 15 (13.5%) eyes were treated with aflibercept and 6 (5.4%) eyes were treated with bevacizumab monotherapy, while 28 (25.3%) eyes were treated with anti-VEGF agents consecutively. Among the consecutively treated group, 20 (18.01%) eyes were treated with ranibizumab followed by vi aflibercept, 8 (7.2%) eyes were treated with bevacizumab followed by ranibizumab. During the follow-up period, the mean number of anti-VEGF injections were 7.06±5.4 (1-36). At the end of the follow-up period, scar formation was seen in 47 (42.5%) of 111 eyes, while in 39 (35%) eyes macular atrophy was developed. Both anatomical and functional improvements were observed. In 19 (17.1%) eyes, PED persisted without scar or atrophy development. Conclusion: During the follow-up, the overall BCVA decrease from baseline was 15 letters. In the first 4 year while BCVA remained stable, it showed a detoriation in the last year. The crucial prognostic factors for visual outcome were scar and atrophy development. These results reveal that PEDs are resistant to therapy. Key Words: Age-related macular degeneration, pigment epithelial detachment, intravitreal anti-VEGF treatment.