Abstract
Purpose :
This study aimed to evaluate the efficacy and safety of subthreshold laser photocoagulation for drusenoid pigment epithelial detachment (PED) patients with intermediate AMD, those effective interventions to prevent progression was currently not available.
Methods :
A prospective, randomized case-control trial was conducted in patients with bilateral drusenoid PED. Treatment-naïve eyes with a visual acuity of ≤83 ETDRS letters were enrolled. The eye with lower vision (or random selection in case of same visual acuity) was assigned to the laser treatment group, and the fellow eye served as a control group. The laser treatment group received PASCAL subthreshold laser along the periphery of the drusen. To prevent complications such as choroidal neovascularization (CNV), intravitreal Bevacizumab injections were performed on a 3 month interval up to one year. Anatomical outcomes (drusen area, PED height and presence of GA or CNV) and functional outcomes (best corrected visual acuity [BCVA], contrast sensitivity, degree of metamorphopsia and VFQ-25) were analyzed.
Results :
A total of 21 patients (mean age 72.6 years) with bilateral drusenoid PED were enrolled. This 12-month interim analysis was done in the 15 patients who satisfied the one-year follow-up period. Mean BCVA change was 3.26 letters in the laser group and 0.47 letters in the control group(p=0.007, 0.602, respectively). Drusen area and PED height decreased significantly in the laser group at month 12 (57.2%, p<0.001; 76.9%, p<0.001, respectively), while no significant change appeared in the control group except increase of PED height in month 9 (110.1%, p=0.10). All other functional parameters besides BCVA showed no significant changes during the follow up visits in both eyes. As for safety, one study eye developed retinal pigment epithelial tear at month 12, and one control eye developed retinal angiomatous proliferation at month 6.
Conclusions :
Subthreshold laser photocoagulation in combination with anti-VEGF injections in eyes with drusenoid PED improves functional and anatomical outcomes without serious complication. Larger, randomized long term clinical trials should be followed to clarify the effect of this treatment protocol for intermediate AMD.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.