Тактика лечения пациентов с сочетанной витреоретинальной патологией: наличием влажной формы возрастной макулярной дегенерации и эпиретинального фиброза. Клинические случаи

Abstract

Introduction. Age-related macular degeneration (AMD) is one of the leading causes of irreversible vision loss among older patients. Since the introduction of anti-VEGF therapy, retinal specialists have been able to maintain or improve vision in patients with AMD. However, anti-VEGF therapy is ineffective in a certain percentage of patients. In 25-35% of cases of wet AMD, secondary epiretinal membranes (ERM) in the macular region are found. Anti-VEGF therapy has been found to be less effective in the treatment of wet AMD with ERM. Optimal treatment tactics for this combined pathology remains a matter of debate. Purpose. To evaluate the efficacy of different combined treatment approaches to patients with wet AMD and ERM. Methods. Study was performed on 2 eyes of 2 patients with ERM and AMD, wet form. Patients were divided in two groups. First patient received one loading dose of anti-VEGF drug (ranibizumab) and after that underwent standart pars plana vitrectomy (PPV) with removal of epiretinal and inner limiting membrane (ILM). Anti-VEGF therapy than was continued according to pro re nata regimen. Second patient underwent standart PPV with removal of ERM and ILM first. After the surgery, loading dose of anti-VEGF drug was injected. Anti-VEGF therapy than was continued according to pro re nata regimen. Results. After treatment, there was a decrease in central retinal thickness in both patients, but an increase in maximum corrected visual acuity was observed only in first patient. Conclusions. Based on the results of the performed study, the most optimal treatment approach to patients with wet AMD and ERM consisted of a single loading dose of anti-VEGF drug injection followed by PPV with removal of ERM and ILM and further continuation of anti-VEGF therapy for wet AMD. However, further research is needed to form a final conclusion about the effectiveness of the chosen treatment tactic. Key words: epiretinal fibrosis, AMD, CNVM, anti-VEGF