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Heinrich Gerding; SD-OCT findings after 10 years of AMD anti-VEGF treatment. Invest. Ophthalmol. Vis. Sci. 2020;61(9):PB0038.
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So far, relatively few information is available on the development of retinal pathology in eyes that have been under care for more than 5 years. It was the aim of this study to demonstrate and classify OCT findings after 10 years of care and to compare these to baseline disease expression.
30 of 104 eyes that started anti-VEGF treatment between 2007 and 2008 could be followed up until the end of year 10 years. During follow-up a mean of 28.6 injections/eye were given. 12 of 30 patients (40 %) still received anti-VEGF injections in year 10.
10 years after treatment initiation 25/30 eyes (83%, baseline: 2 /30 eyes 7%) presented confluent RPE atrophy. In 19 of these (63 %) atrophy included the complete fovea. RPE-detachment was found in 23 /30 eyes (77%) at baseline. In 3 eyes (10%) RPE-detachment disappeared during follow-up and in 5 (17 %) it developed and persisted until year 10. Finally, RPE-detachment or subretinal fibroses after destruction of detached RPE was found in 25 eyes (83%). In 24 of these eyes (96%, 80% of all) sub-RPE fibrovascular proliferation had developed during follow-up and had transformed to dense fibrous tissue. The latter was in 8 eyes (33%) still covered by RPE. Subretinal fluid was present finally in 4 eyes (13%, baseline 17 eyes - 57%). Intraretinal fluid (>microcystic) was found finally in 9 of 30 (30%) compared to 21 eyes 70%) at baseline. It was striking that eyes with huge pseudo-cystic intraretinal fluid deposition or with multiple nearly confluent cystic intraretinal hyperfluorescence at baseline tended to develop large RPE atrophy until final examination. 11/12 eyes (92%) with minimal classic or predominantly classic neovascular membranes at baseline developed geographic atrophy at the position or in close proximity of the classical component. Although multiple structural changes had occurred, visual acuity was <0.31 logMAR in 30 % and <1.0 log MAR in 67% of all eyes finally.
The majority of all eyes observed presented either confluent atrophy or/and subretinal/sub-RPE development of massive fibrous tissue. Though nearly all cases developed progressive pathological changes during follow-up a considerable proportion of all patients presented a relatively favourable functional outcome. Both, structure and function under anti-VEGF treatment are considerably better than previously reported data on the natural course of nAMD.
This is a 2020 Imaging in the Eye Conference abstract.
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