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A. P. Lommatzsch, B. Heimes, G. Spital, M. Gutfleisch, D. Pauleikhoff; Funktional and Morphological Results of Anti-VEGF Treatment of Vascularized Pigment Epithelial Detachment. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1889.
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In the past, serous pigment epithelial detachment (PED) associated with exudative AMD was considered to be a special morphological form of the disease as regards treatment options. This study presents the long-term functional and morphological results of anti-VEGF treatment.
The data from 274 consecutive patients with PED were retrospectively assessed. The mean patient age was 77.9 years. In all, 86 patients were treated with bevacizumab, 128 with ranibizumab, and 60 with pegaptanib. The best-corrected visual acuity was determined by LogMAR. Additional morphological parameters included foveal full thickness (OCT), manual measurement of the height of the PED, and FAG/ICG angiography. Anti-VEGF treatment was administered three times at 4-week intervals. The mean observation period comprised 49.2 weeks. To better analyze the course of disease we divided the patients into quartiles, whereby quartile 1 was defined as those patients with the best baseline values and quartile 4 the patients with the poorest baseline values.
The mean change in visual acuity for all was -0.07 for bevacizumab, -0.1 for ranibizumab, and +0.04 for pegaptanib. Only in quartile 3 patients was visual acuity significantly improved (p= 0.001). The central retinal thickness as measured by OCT was significantly different between patients in all quartiles (p=0.013). The correlation between retinal thickness and visual acuity was only significant in patients in quartiles 3 and 4. In contrast, the height of the PED before beginning treatment had no effect on visual acuity improvement.
Anti-VEGF is effective in the treatment of serous PED associated with exudative AMD. Visual acuity and morphology improves slightly. Retinal thickness and thus intraretinal and subretinal accumulation of fluid can be reduced and is also associated with an improvement in visual acuity. Because of the risk of pigment epithelial detachment, central retinal thickness represents a decisive criterion for making treatment recommendations.
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