Rheopheresis in the treatment of non-exudative AMD

Abstract

Purpose: Non-exudative AMD is a cause of visual impairment for which the therapeutic arsenal is limited. Rheopheresis is an application of double filtration plasmapheresis specifically designed to treat microcirculatory disorders. Preliminary studies tended to show that this treatment could reduce the number of drusen in AMD and reduce the frequency of neovascular complications. The objective of this study was to evaluate the effect of rheopheresis on the evolution of visual acuity, progression of atrophy and transition to exudative AMD over 24 months in non-exudative AMD.

Methods: This prospective randomized controlled trial was conducted on patients with non-exudative AMD (stage 3 and 4) and was approved by the French ethics committee (ref 2006-A00671-50). All patient received AREDS-type vitamin supplementation. They were randomized into 2 groups: rheopheresis treatment or control group. Patients were followed for two years. The parameters studied every six months were best-corrected visual acuity, retinal autofluorescence with area of atrophy measurement (RegionFinder®) and central macular thickness on optical coherence tomography. Fluorescein angiography, central visual field and quality of life questionnaire “VQF 25” were evaluated at the beginning and end of the study. Blood biochemical tolerance was also monitored.

Results: 21 eyes of 21 patients (17 women, 4 men) with non-exudative AMD were followed from July 2009 to May 2013 (10 rheopheresis-treated and 11 controls). The average age of the patients was 78.3 ± 11.0 years for the rheopheresis group and 72.3 ± 8.2 years for the control group (p = .420). For the rheopheresis and control groups respectively, visual acuity decreased from 0.39 and 0.46 logMAR at baseline (p= .398) to 0.49 and 0.68 logMAR at 12 months (p = .142) and to 0.65 and 0.81 logMAR at 24 months (p= .219). The area of macular atrophy increased from 5.79 and 8.75 mm2 at baseline (p= .050) to 7.64 and 10.88 mm2 at 12 months (p= .132) and to 10.14 and 12.96 mm2 at 24 months (p= .121) for the rheopheresis and control group respectively.

Conclusions: Changes in visual acuity and in atrophic area showed no statistically significant difference at 24 months between rheopheresis-treated patients and controls in non-exudative AMD. Rheopheresis did not seem to be effective in slowing the progression of non-exudative AMD in this small series.

Keywords: 412 age-related macular degeneration • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • 754 visual acuity