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Andres Gonzalez, Gibran S Khurshid; Treatment of refractory pigment epithelial detachment secondary to exudative age-related macular degeneration.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1944.
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© ARVO (1962-2015); The Authors (2016-present)
Pigment epithelial detachment (PED) occurs approximately in 62% of eyes with neovascular age-related macular degeneration (AMD). The treatment for PED is unpredictable and results in unsatisfactory outcomes despite the availability of a multitude of available anti-vascular endothelial growth factor (anti-VEGF) options. This case series evaluated the combination of photodynamic therapy and anti-VEGF in patients with a PED.
We analyzed six consecutive patients between September 1, 2015 and July 1, 2016 with a PED secondary to neovascular AMD who were treated with full fluence standard PDT and an anti-VEGF injection (Lucentis 5 units) followed by a regular anti-VEGF schedule that ranged from 3-12 subsequent monthly injections. Follow-up ranged between 5 to 13 months, with continuation of their anti-VEGF injection schedule. Variables collected for the purpose of this study included baseline best-corrected visual acuity (BCVA) converted to logMAR (logarithm of minimum angle of resolution), central macular thickness (CMT), and maximum PED height. This information was then reviewed at subsequent follow-ups.
The PED completely resolved in all eyes, with initial PED heights ranging from 147 – 664 µm. Central macular thickness was reduced by an average of 259.0 µm (59% average reduction, range -34 to -612 µm), p = 0.03 (CI 95% 37.39 – 480.61). Mean logMAR VA improved from 0.795 (Snellen equivalent 20/125, [20/40 to 20/400]) to 0.446 (Snellen equivalent 20/55, [20/30 to 20/200]), p = 0.008 (95% CI .128 – 0.571). No complications were observed in our patients.
A PED in the setting of neovascular AMD showed an excellent response to a combined multimodal approach that includes PDT with an anti-VEGF injection followed by a monthly anti-VEGF schedule. Most importantly, visual acuity showed a significant improvement from baseline. If confirmed by future studies, this would offer another treatment avenue for this difficult-to-treat consequence of neovascular AMD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Left: Mac OCT prior to commencement of PDT/Anti-VEGF treatment in 3 patients Right: Mac OCT after PDT and initial injections.
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