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Florian Alten, Christoph Roman Clemens, Friederike Schubert, Nicole Eter; Morphologic characteristics of a treatment poor-responsive fibrovascular pigment epithelium detachment type due to age-related macular degeneration . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5386.
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Intravitreal anti-VEGF therapy has become a successful and established treatment strategy in neovascular age-related macular degeneration (AMD). However, it is known that some patients do not respond satisfactorily despite regular treatment. The aim of the study was to describe morphologic characteristics of poor-responsive fibrovascular pigment epithelium detachment (fPED) due to AMD.<br />
A retrospective study of 324 consecutive neovascular AMD patients was performed. All patients received three initial consecutive monthly intravitreal injections with ranibizumab or aflibercept and were controlled monthly thereafter and treated as needed. Spectral-domain optical coherence tomography (SD-OCT) was performed at all control visits. Fluorescein angiography (FA) was performed at baseline and if disease activity was questionable based on SD-OCT during follow-up. We included 45 patients with a fPED and a follow-up of 12 months. Morphologic poor response was defined as persistent subneurosensory fluid during follow-up visits.<br />
22 (48.9%) of the included fPED patients showed a poor response to anti-VEGF therapy with a high number of injections (7.6/year). Mean visual acuity was 0.35 at baseline and 0.37 at 12-months follow-up. Development of geographic atrophy was present in no patient. 16 (72.7%) of the poor responsive fPED patients showed the following morphologic characteristics: A stippled hyperfluorescence followed by persistent staining within the retinal detachment in FA, an intact RPE band, an intact external limiting membrane, a recurrent subneurosensory slit of fluid and an increasingly hyperreflectivity filling the entire PED in SD-OCT scans.<br />
The described poor-responsive fPED type can be clearly set apart from a fibrotic lesion. Supposedly, morphologic changes seen in SD-OCT may be interpreted as maturization of CNV membrane including the ingrowth of pericytes which may cause poor-response to anti-VEGF therapy.<br />
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