Intravitreal Lucentis For The Treatment Of Amd Related Pigment Epithelial Detachment

Abstract

Purpose: : Exudative age-related macular degeneration (AMD) results in a significant and severe visual loss if left untreated. Despite numerous trials studying the effect of anti-VEGF agents on AMD, there is an absence of literature on clinical outcomes for pigment epithelial detachments (PED) as most previous AMD trials have excluded patients with lesions composed of primarily blood or PED. The purpose of this study is to determine the response of predominantly PED type lesions to intravitreal Lucentis, the current gold standard therapy in AMD treatment.

Methods: : This was a non-blinded prospective study. Patients were selected from the practices of three retinal surgeons’ between August 2008 and December 2010. Patients with predominantly fibrovascular PED type lesions (as classified on IVFA and OCT) secondary to AMD were eligible for inclusion. Patients received monthly intravitreal Lucentis injections for 6 months. At 6 months, patients were evaluated based on ETDRS visual acuity and OCT to determine response to Lucentis therapy. Patients not experiencing a visual improvement from baseline ETDRS acuity or not showing a reduction in the height of the fibrovascular PED were deemed Lucentis non-responders. These patients received no further Lucentis injections, but underwent re-evaluation at 12 months. Patients deemed responders continued with OCT-guided active treatment on a prn basis for an additional six months.

Results: : Thirty-one patients were enrolled in this study, with two being lost to follow-up. Twelve males and 17 females with a mean age of 79.3 years (range: 57-94) were included in this study. The baseline visual acuity for all patients was 63.3 +/- 12.8 letters, and at twelve months was 66 +/- 18.9 letters (p= 0.45). Twenty-three patients (79.3 percent) were deemed Lucentis responders. For these patients, the mean visual acuity at baseline was 65.7 +/- 12.6 letters, and improved to 71.9 +/- 11.7 letters at twelve months (p<0.05). Their average PED height (as measured by OCT) changed from 311.41 +/- 163.15 μm at baseline to 230.00 +/- 114.13μm at twelve months (P <0.05). Seven Lucentis responders (30 percent) had complete resolution of their PED by twelve months of treatment. Three patients developed RPE tears while on treatment.

Conclusions: : Most patients with predominantly PED type lesions secondary to AMD responded to monthly intravitreal Lucentis therapy. Patients who had an initial response to Lucentis had a significant improvement in visual acuity and PED size at twelve months of treatment. This suggests that monthly intravitreal Lucentis may serve an important role in the treatment of predominantly PED type lesions in AMD.

Clinical Trial: : http://www.clinicaltrials.gov NCT00841581

Keywords: age-related macular degeneration • retinal pigment epithelium • vascular endothelial growth factor