Response of Pigment Epithelial Detachment to Three-Loading-Dose of Intravitreal Anti-Vascular Endothelial Growth Factor in Neovascular Age-Related Macular Degeneration

Abstract

Objective: Response of pigment epithelial detachment (PED) to three loading dose of intravitreal bevacizumab (IVB) treatment in neovascular age-related macular degeneration (nAMD) cases. Methods: OCT findings (PED height (µm), diameter(µm) and area (mm²), central macular thickness (CMT), central choroidal thickness (CCT), intraretinal fluid (IRF), subretinal fluid (SRF)), and morphological features of macular neovascularization (MNV) in OCTA before and after three loading doses of IVB were examined and compared. Results: Forty-two eyes of 42 naive nAMD patients with PED were included. Fifteen patients had serous and 27 patients had fibrovascular PED. After three loading doses, best corrected visual acuity (BCVA) (in Snellen) increased from 0.22±0.19 to 0.29±0.22 (p<0.001). The mean PED height, width and area decreased (323.46±189.80 µm,274.79±199.80 µm, p=0.007; 1639.87±1037.44 µm, 1599.01±993.88 µm, p=0.138; 2.90±2.76 mm², 2.24±2.38 mm², p=0.038 respectively). CMT decreased from 500.34±286.62 µm to 366.14±238.10 µm, CCT decreased from 251.55±74.44 µm to 197.09±50.36 (p<0.001 for both). IRF or SRF were significantly regressed (p=0.008 and p=0.032). Branching decreased from 23.8% of patients to 11.9% (p=0.044), loops completely regressed (p<0.001), hypointense halo decreased from 7.1% of patients to 4.6% (p=0.323), open circulation decreased from 23.8% to 4.6% (p<0.001). Seafan and medusa NV were present in 2.3% and 4.6% of patients, however did not differ. The pruned tree NV increased from 11.9% to 33.3% (p<0.001). Closed circulation increased from 33.3% to 38% (p=0.083). Discussion: After three loading doses of IVB, PED height and area were significantly reduced and also 21.4% of PED completely regressed and 52.3% of PED decreased. MNV with PED, particularly brancing, loops had regressed, and most of the pruned tree formations were increased and some of the open circulations were converted to closed circulation. In conclusion, 3 loading doses IVB decreased the size a half of PEDs and changed feature of MNVs with PED.

Keywords

• pigment epithelial detachment
• neovascular age-related macular degeneration
• optical coherence tomography
• optical coherence tomography angiography

Neovasküler Yaşa Bağlı Makula Dejenerasyonunda Bulunan Pigment Epitel Dekolmanının Üç Yükleme Dozu İntravitreal Anti-Vasküler Endotelyal Büyüme Faktörüne Yanıtı

Öz

Giriş: Neovasküler yaşa bağlı makula dejenerasyonu (nAMD) olgularında pigment epitel dekolmanının (PED) üç yükleme dozu intravitreal bevacizumab (İVB) tedavisine yanıtının incelenmesi. Yöntem: OKT bulguları (PED yüksekliği, çapı ve alanı, merkezi makula kalınlığı (MMK), merkezi koroidal kalınlık (MKK), intraretinal sıvı (IRS), subretinal sıvı (SRS)) ve OKTA'da makuler neovaskülarizasyonun (MNV) morfolojik özellikleri İVB'nin üç yükleme dozundan önce ve sonra incelendi ve karşılaştırıldı. Sonuç: PED'li 42 naif nAMD hastasının 42 gözü dahil edildi. Onbeş hastada seröz ve 27 hastada fibrovasküler PED vardı. Üç yükleme dozundan sonra en iyi düzeltilmiş görme keskinliği (EİDGK) (Snellen'de) 0,22±0,19'dan 0,29±0,22'ye yükseldi (p<0,001). Ortalama PED yüksekliği, genişliği ve alanı azaldı (323,46±189,80 µm,274,79±199,80 µm, p=0,007; 1639,87±1037,44 µm, 1599,01±993,88 µm, p=0,138; 2,90±2,76 mm², 2,24±2,38 mm², p= sırasıyla 0.038). MMK 500,34±286,62 µm'den 366,14±238,10 µm'ye, MKK 251,55±74,44 µm'den 197,09±50,36'ya düştü (her ikisi için p<0,001). IRS veya SRS anlamlı olarak geriledi (p=0,008 ve p=0,032). Dallanma şeklindeki NV, hastaların %23,8'inden %11,9'una (p=0,044), loops tamamen geriledi (p<0,001), hipointens halo hastaların %7,1'inden %4,6'sına (p=0,323), açık dolaşım %23,8'den 4,6'ya düştü % (p<0.001). Seafan ve medusa NV hastaların %2,3'ünde ve %4,6'sında mevcuttu ancak sebaat etti. Budanmış ağaç NV %11,9'dan %33,3'e yükseldi (p<0,001). Kapalı dolaşım %33,3'ten %38'e yükseldi (p=0,083). Tartışma: Üç yükleme dozu İVB sonra, PED yüksekliği ve alanı anlamlı olarak azaldı ve ayrıca PED’lerin %21,4’ü tamamen geriledi ve %52.3’ü küçüldü. MNV’laradan, özellikle dallanma, loops geriledi ve budanan ağaç formasyonu arttı ve açık sirkülasyonların bir kısmı kapalı sirkülasyona dönüştü. Sonuç olarak, üç yükleme dozu IVB, PED'lerin yarısına etki ederek boyutunu küçülttü ve MNV'lerin morfolojik özelliklerini değiştirdi.

Kaynakça

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