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[Retinal angiomatous proliferation with associated pigment epithelium detachment: anti-VEGF therapy]
A Lommatzsch1, B Heimes, M Gutfleisch
1Augenabteilung, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland. Albrecht.Lommatzsch@web.de
Background:
Vascularized pigment epithelial detachment (PED) in retinal angiomatous proliferation (RAP) represents a special morphological form of exudative age-related macular degeneration (ARMD) in the natural course and in the frequency of complications, such as tears in the pigment epithelium. In this study the results of inhibition of vascular endothelial growth factor (VEGF) for exudative ARMD with associated PED and RAP were examined.
Materials And Methods:
Functional and morphological data were retrospectively collected for 61 consecutive eyes with RAP in stages 2 and 3 over an average observation period of 108 weeks. Patients were treated with bevacizumab (n=15), ranibizumab (n=29) and pegabtanib (n=17) according to the recommendations of the German Society of Ophthalmology (DOG) and the German Retina Society (RG). After an initial treatment cycle of 3 injections every 4 weeks (6 weeks for pegabtanib), best corrected visual acuity (BCVA), fluorescence angiography (FAG), indocyanine green angiography (ICG-A) and optical coherence tomography (OCT) were evaluated every 12 weeks.
Results:
The mean visual acuity was 0.8 logMAR before therapy and 0.77 logMAR after therapy so that the average difference to the original acuity was -0.03 logMAR after 12 weeks and 0.00 logMAR after 48 weeks. The central retinal thickness measured by OCT decreased on average by 81.2 µm after the first cycle of injections and by -68.4 µm after 1 year. The maximum depth of PED could be reduced on average by 1 unit and after 1 year by 1.55 units. Better functional and morphological results were obtained by therapy with ranibizumab and avastin compared to pegabtanib (p=0.03). An RIP occurred in 9.8% of the patients (n=6) on average after 16 weeks.
Conclusions:
The morphological functional results can be improved in the early months using the therapy strategy presently recommended in Germany. However, in later stages there was a significant worsening of the functional results. Modification of the treatment strategy with respect to close surveillance and possibly early stage repeat treatment would seem advisable.
Insights
Anti-VEGF treatments like ranibizumab and bevacizumab show initial improvements for exudative age-related macular degeneration (ARMD) with pigment epithelial detachment (PED) and retinal angiomatous proliferation (RAP). However, long-term results may worsen, suggesting treatment strategy modifications are needed.
Area of Science:
- Ophthalmology
- Medical Retina
- Age-Related Macular Degeneration (ARMD)
Background:
- Vascularized pigment epithelial detachment (PED) is a specific form of exudative age-related macular degeneration (ARMD), often seen in retinal angiomatous proliferation (RAP).
- Complications like pigment epithelium tears are frequent in this condition.
- The study examines the efficacy of vascular endothelial growth factor (VEGF) inhibition for exudative ARMD with PED and RAP.
Purpose of the Study:
- To evaluate the functional and morphological outcomes of anti-VEGF therapy in patients with exudative ARMD, specifically those with PED and RAP.
- To compare the effectiveness of different anti-VEGF agents (bevacizumab, ranibizumab, pegabtanib) in treating this condition.
Main Methods:
- Retrospective analysis of 61 eyes with RAP (stages 2 and 3) over an average of 108 weeks.
- Patients received bevacizumab (n=15), ranibizumab (n=29), or pegabtanib (n=17) following German guidelines.
- Evaluations included best-corrected visual acuity (BCVA), fluorescein angiography (FAG), indocyanine green angiography (ICG-A), and optical coherence tomography (OCT) at regular intervals.
Main Results:
- Mean visual acuity improved slightly initially (-0.03 logMAR at 12 weeks) and stabilized (0.00 logMAR at 48 weeks).
- Central retinal thickness decreased significantly post-treatment (81.2 µm) and at 1 year (-68.4 µm).
- Ranibizumab and bevacizumab showed better results than pegabtanib (p=0.03); RPE tears occurred in 9.8% of patients.
Conclusions:
- Current German treatment strategies for ARMD with PED and RAP can improve outcomes in the initial months.
- Functional results showed significant worsening in later stages.
- Modified treatment strategies, including close surveillance and early repeat treatments, are recommended.
