Session Title: Free Paper Session 27: AMD VI
Session Date/Time: Sunday 10/09/2017 | 12:00-13:30
Paper Time: 12:24
Venue: Room 117
First Author: : R.Fayzrakhmanov RUSSIA
Co Author(s): : M. Bikbov
To evaluate combined method of therapy for hidden neovascularization in combination with a detachment of the retinal pigment epithelium in age-related macular degeneration
Ufa Eye Research Institute, Ufa, Russia
We observed 12 patients with high detachment of the retinal pigment epithelium (RPE) on the background of hidden choroidal neovascularization (CNV). Patients underwent a complete ophthalmological examination, including microperimetry optical coherence tomography (OCT), fluorescein angiography. Corrected visual acuity before treatment was 0,2 ± 0,07. Point of fixation was located in foveolar area in physiological position according to microperimetry. OCT was performed before and 1 and 3 months after surgery. RPE detachment was determined on OCT with height up to 1200 ± 200 µm with an optically transparent content underneath. Indications for surgery were the height of the RPE detachment of more than 800 µm, and resistance to previously received anti-VEGF therapy. Technique of surgical treatment is to perform subtotal vitrectomy 25 G, drainage of RPE detachment with retinal spatula at the bottom edge of the bubble. After draining RPE all patients underwent laser coagulation of retinotomical area and vitreous cavity tamponade by 16% gas mixture (C2F6). Patients were divided into two equal groups: • Group 1 (6 eyes) - only drainage of subretinal fluid without intravitreal administration of drugs was carried out; • Group 2 (6 eyes) - drainage of subretinal fluid with simultaneous intravitreal anti-VEGF injection was performed.
By the end of the first month of observation, all patients reported disappearance of object distortion, visual acuity improved in both groups and was 0.3 ± 0.03. Anatomical attachment of retina layers was noted according to OCT, but the destruction of the pigment epithelium and photoreceptors remained. Structure without signs of activity - neovascular membrane was visualized under the RPE. The thickness of the retina in the fovea was 176 ± 8 µm. 3 months after surgery, 4 patients (67%) of Group 1 noted the deterioration of central vision to 0.25 ± 0.04. RPE detachment relapse with the rise of the dome to 100 microns was noted during the OCT in the macular area. The absence of complete relief of the pathological process was due to CNV activity. Repeated surgery was not carried out. Visual acuity of 0.4 ± 0.05 and no pathological changes in the macular area was identified in patients of the group 2 by the end of the 3d months of observation. CNV activity was reduced by means of anti-VEGF therapy. The thickness of the retina in the foveolar area corresponded to 184 ± 11 µm.
Hidden neovascular membrane with high detachment of retinal pigment epithelium causes a comprehensive approach to the therapy. Drainage of subretinal fluid with intraoperative administration of anti-VEGF at high RPE detachment provides improvement of visual acuity, achievement of anatomical attachment of retina layers in the macula during the postoperative period.