Session Title: Free Paper Session 9: AMD III
Session Date/Time: Friday 08/09/2017 | 08:00-09:30
Paper Time: 09:12
Venue: Room 117
First Author: : A.Kamal UK
Co Author(s): : L. Makris
To evaluate the efficacy and safety of a combination treatment using Sulfur hexafluoride (SF6) gas and anti-VEGF treatment in patients with SMH associated with Wet ARMD which can potentially cause irreversible visual loss.
University of Aintree (UHA) – Retinal department in a Tertiary referral centre in Liverpool UK.
A retrospective, non-randomized consecutive case series of 42 eyes from 42 patients with SMH associated to Wet ARMD treated with one intravitreal SF6 absolute gas along with head posturing and a course of three intravitreal injections anti-VEGF Ranimizumab in a monthly basis for three months. Clinical details recorded before the treatment with documentation of Log-MAR Best Correct Visual Acuity (BCVA), measurement of Intraocular Pressure (IOP), Slit lamp examination, Fluorescein Angiography (FFA), Indocyanine Green Angiography (ICGA) and Spectral Domain Optical Coherence Tomography (SD-OCT). Patients were selected on the basis of presence of sub-retinal (subfoveal, submacular) haemorrhage which is usually of sudden onset in patients with wet ARMD. The duration of haemorrhage ranged from a month to 4 months. Those patients who were unable to posture were excluded from the study. Data was extrapolated from medical records and Medisoft® software. Imaging was performed on Spectralis Heidelberg SD-OCT along with LOGMAR visual acuity.
Our study included 42 eyes from 42 patients (M: F=21:21) with SMH associated to Wet ARMD with average age of 83. For the purpose of this study we classified the results in 3 groups according to the BCVA outcome compared to baseline, group 1 were BCVA improved more or equal 1 Log-MAR line, group 2 were BCVA not improved or worsen more than 1 log-MAR line and the group 3 were the BCVA worsen more than 1 log-MAR line. Post treatment the BCVA improved more or equal with 1 log-MAR (group 1) lines 27 out of 42 eyes (64%), remains stable (group 2)not improved or worsen more than 1 log-MAR line 10 out of 42 eyes (24%) and 5 out of 42 eyes (12%) worsen (group 3) more or equal with 1 log-MAR line. The mean pretreatment Central Macular Thickness (CMT) was 475 µm and the mean post treatment CMT was 338 with a mean decrease in CMT by 134µm. More than 85% of the patients documented with known history of Hypertension. Perioperative and postoperative complications will be discussed.
Choroidal Neovascular Membrane (CNVM) is a common cause of SMH. Treatment, if delayed, leads to poor recovery with destructive effects on photoreceptors. The option of SF6-gas combined with anti-VEGF injection as a treatment in SMH associated to wet ARMD was described earlier in a smaller study using Bevacizumab. It works by mechanically displacing the sub foveal haemhorrage inferior part of the retina using the head posture. This study of combo treatment has shown an average improvement of BCVA by 13.2 log-MAR letters, and an average decrease in CMT by 134µm with best results achieved in those with recent haemhorrage as opposed to longstanding prior to the depletion of the photoreceptors. Overall it seems to be safe and efficacious, quick office based procedure which can help to retain useful vision in complex wet ARMD.