Yaş Tip Yaşa Bağlı Makula Dejenerasyonu Nedeniyle Intravitreal Ranibizumab, Bevacizumab, Pegaptanib veya Bunların Ardışık Tedavileri Uygulanan Hastaların Uzun Dönem Görsel ve Anatomik Sonuçlarının Retrospektif Değerlendirilmesi

Abstract

The purpose of this study is investigation of long term visual and anatomic outcomes retrospectively in patients who had undergone intravitreal ranibizumab, bevacizumab, pegaptanib monotherapies or consecutive therapies of these agents because of neovascular age related macular degeneration and followed for more than one year, and evaluation of effect these therapies on vision level and macular thickness. For this purpose, 82 patients who had undergone ranibizumab monotherapy (group 1) and 10 patients who had undergone consecutive therapies with more than 1 agent (group 2), a total of 92 patients were included in the study. Consecutive therapies were bevacizumab and ranibizumab in 7 patients, pegaptanib and ranibizumab in 3 patients. Patients receiving only bevacizumab and only pegabtanib therapy couldn't be included in the study as to all medical data of these patients were not available. Visual acuity and macular thickness of patients were analysed retrospectively. Average age of the patients was 72.3 ± 6.6 months (57-85), average follow-up period was 47.5 ± 13.5 months (24-75) and average number of visits was 25.4 ± 10.1 (8-49). In the follow-up period, for ranibizumab group average 7.7 ± 4.4 (2-21) and for consecutive therapy group average 9.1 ± 3.9 (2-15) injection was performed. In ranibizumab group initial average best corrected visual acuity (BCVA) was 48,4 ± 15 (15-76) letters, it was 51,2 ± 20 (1-80) letters in first year, 45,9 ± 19 (1-80) letters in second year, 43,7 ± 21 (3-80) letters in third year, 47,6 ± 23 (5-80) letters in fourth year, and 48,7 ± 19 (7-75) letters in fifth year. In consecutive therapy group initial average BCVA was found as 52,4 ± 16 (28-78) letters, it was 48,2 ± 15 (31-73) letter in first year, 31,1 ± 22 (2-70) letters in second year, 38,6 ± 2 (5-70) letters in third year, 37,0 ± 24 (15-77) letters in fourth year, and 42,5 ± 18 (30-55) letters in fifth year. The change in the visual acuity showed similar pattern in both groups. But, while at the begining of the study 92 patients were evaluated, that number decreased to 66 patients at the third year and to 24 patients at the fifth year. Because of the big difference in patient numbers, statistical analysis for comparing visual acuity change between two groups, could not be performed. The initial average macular thickness was 300 ± 76 (178-552) microns in ranibizumab therapy group, it was found as 273 ± 82 (166-647) microns at first year, 277 ± 90 (131-666) microns at second year, 275 ± 106 (142-734) microns at third year, 262 ± 81 (160-587) microns at fourth year, and 245 ± 49 (138-359) microns at fifth year. In consecutive therapy group, initial average macular thickness was measured as 332 ± 69 (208-403) microns, 320 ± 98 (183-460) microns at first year, 362 ± 148 (200-633) microns at second year, 383 ± 140 (259-677) microns at third year, 363 ± 194 (215-768) microns at fourth year, and 266 ± 44 (236-316) microns at fifth year. At the end of the follow-up period, of 92 patients included in the study, in 62 patients macular scar, in 7 patients macular atrophy developed. In conclusion, with ranibizumab monotherapy or consecutive therapies, visual acuity can be maintained about 3 years, but in most of the patients geographic atrophy or scar developed.