Анализ влияния отслойки ретинального пигментного эпителия при экссудативной форме возрастной макулярной дегенерации на долгосрочные результаты лечения

Abstract

Retinal pigment epithelial detachments (RPE) develops in more than 80 % of eyes with exudative age-related macular degeneration (eAMD) [1, 2]. RPED is a pathological condition in which the retinal pigment epithelium separates from the underlying Bruch's membrane due to the formation of a fibrovascular membrane, drusenoid material, fluid and/ or blood accumulation [3]. Recent published data from studies have shown controversial results of treatment with anti-VEGF therapy in patients with ARD on the background of eAMD, possibly due to different diagnostic capabilities and interpretation of the results by specialists. Purpose. To study the response to anti-VEGF therapy in patients with various RPED in eAMD. Material and methods. The study included 221 patients: with serous vascular (55 eyes) and fibrovascular detachment of RPE (176 eyes). To determine the maximum height of the retinal pigment epithelium detachment, it was necessary to manually set a line from Bruch's membrane to the retinal pigment epithelium in the scan where the maximum detachment of the retinal pigment epithelium was detected. Antiangiogenic therapy was carried out using the drug Aflibercept (Eylea® / Eulea®, Bayer Pharma AG, Mullerstrasse 178, 13353 Berlin, Germany) according to the standard method using the treat & extend regimen (treat and prolong). Results. A significant increase in BCVA was found in patients with 1st type neovascularization and PCV during the first year of therapy from 0.51 ± 0.18 to 0.58 ± 0.23 and from 0.66 ± 0.23 to 0.76 ± 0.20 (p < 0.05), with a further gradual significant decrease and return from baseline BCVA by 3rd year to 0.51 ± 0.25 (p < 0.05) in the group with 1st type CNV, in patients with PCV, there was also a decrease in BCVA, but this was unreliable. BCVA values in all four groups decreased by the 6th year of observation. There was a significant decrease in the height of RPED in the group with the 1st and 3rd types of neovascularization, as well as in patients with PCV during the first 2 years of therapy (p < 0.05). Сonclusions. Thus, a significant increase in BCVA in the first year of therapy in patients with ARD is more common in 1st type CNV and with PCV. At the same time, in all groups, after 6 years of treatment, a downward trend in BCVA can be observed. Also, in all groups, there was a decrease in the height of RP, which indicates a good response of the fluid under RP to the ongoing anti-VEGF therapy. Keywords: exudative form of retinal pigment epithelium detachment, anti-VEGF therapy, aflibercept, retinal pigment epithelium detachment