First Author: S.Sakhnov RUSSIA
Co Author(s): S. Sakhnov A. Zabolotniy A. Malafeev A. Bronskaya 0 0 0 0 0 0 0 0 0
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To determine retrospectively OCT-criteria for a potential development of PE morphological changes at A-VEGF therapy of patients with wet AMD, which is accompanied by high pigment epithelium (PE) detachment, for predicting of possible treatment outcome and determination of the optimal mode of A-VEGF injection.
FSBI “The Academician S.N. Fyodorov IRTC “Eye Microsurgery” of the Ministry of Public Health of the Russian Federation, Krasnodar Branch
The retrospective analysis of OCT data and functional results of treatment of 300 eyes with AMD wet form by intravitreal A-VEGF injection was performed. Diagnosis is confirmed by the OCT, fluorescent angiography (FAG) and ophthalmoscopy data. The qualitative analysis of the original OCT in the group I – with no changes in the PED after A-VEGF therapy (11 eyes), in the group II – with PE tear after A-VEGF therapy (6 eyes) and in the group III - with PE high detachment reattaching (7 eyes), was carried out. The patients’ ages were from 70 to 83 years. OCT of retinal macular zone was performed with SOCT CIRRUS HD (Carl Zeiss) with a resolution of 5 microns, before the treatment and 1 month after the injection. FAG was carried out as required according to the standard procedure.
In general group of patients the high PE detachment was detected in 24 people, which was 8%. One month after intravitreal A-VEGF injection 6 PE tears were defined, which was 2%. In 7 eyes PE was reattached (2.5%). In other cases, the PED morphology didn’t changed - 11 eyes (4%). In all studied eyes of the first group in the macular zone according primary OCT data there were high cystic pigment epithelium detachment without defects, budding zones of choroidal neovascularization (CNV) and subretinal exudative activity. The patients of the second group in the macular zone according primary OCT had Bruch's membrane shielding and wrinkled form of PE elevation not more than 500 microns. Pigment epithelium defect was identified only in 1 case, exudative neuroepithelium detachments in all cases were local. OCT data in the third group of patients were characterized by the presence of common neuroepithelium detachments, high cystic PE detachments (up to 800 microns), defect visualization in PE and budding zones of choroidal neovascularization (CNV) in PE, prevalence rate of more than 1000 microns.
OCT-criteria of PE tear risk, leading to a permanent visual acuity reduction in A-VEGF therapy of patients with wet AMD are: 1. The intensity of subretinal exudation: neuroepithelium local detachment with prevalence of not more than 300 microns; Bruch's membrane shielding. 2. The PE detachment form: wrinkling; height up to 500 microns. 3. PE status: absence of defects in the PE; budding zone of CNV in the PE with prevalence of less than 700 microns. The absence of defects in the PE, Bruch's membrane shielding, exudative subretinal activity, is prognostic criteria of wet AMD resistant to the A-VEGF therapy. The presence of OCT risk components of PE tear in patient requires increased caution in planning A-VEGF therapy, as well as the choice of repeated injections individual mode. The presence of OCT resistance signs to A-VEGF therapy raises the question of advisability of intravitreal injections treatment refusing.