Treatment of retinal pigment epithelial detachment secondary to exudative age-related macular degeneration

Abstract

PurposeThis pilot study evaluated the combination of photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF) as a treatment in patients with a pigment epithelial detachment (PED) due to exudative age-related degeneration (AMD).MethodsWe analyzed seven consecutive patients between September 1, 2015 and September 1, 2017 with a PED secondary to exudative AMD who were treated with full fluence standard PDT and a series of monthly intravitreal anti-VEGF injections. Follow-up ranged between 3 and 24 months. Variables collected for the purpose of this study included baseline best-corrected visual acuity converted to logMAR (logarithm of minimum angle of resolution), central macular thickness, and maximum PED height. This information was then reviewed at subsequent follow-ups.ResultsThe PED completely resolved in 4/7 eyes while three patients had a significant improvement in PED size with a corresponding improvement in visual acuity. Initial PED heights ranged from 147 to 423 μm and was reduced by an average of 255.7 μm (83.2% average reduction, range −143 to - 405 μm). Initial CMT ranged from 223 to 719 μm and was reduced by an average of 225.7 μm (54.4% average reduction, range −88 to - 529 μm). Mean logMAR VA improved from 0.669 (Snellen equivalent 20/93, [20/40 to 20/200]) to 0.269 (Snellen equivalent 20/37, [20/25 to 20/80]) at last follow-up. No complications were observed in our patients.Conclusions and ImportancePED in the setting of exudative AMD showed an excellent response to a combined multimodal approach that includes PDT with intravitreal anti-VEGF injection followed by a monthly anti-VEGF schedule. Most importantly, visual acuity showed a significant improvement from baseline. If confirmed by future studies, this would offer another treatment avenue for this difficult-to-treat consequence of exudative AMD.

Response to brolucizumab treatment for refractory serous pigment epithelial detachment secondary to polypoidal choroidal vasculopathy

“…PED can occur in up to 62.7% of eyes with n-AMD [ 6 ]. The treatment for PED is unsatisfactory, although multiple anti-VEGF agents are available [ 23 ]. The previous study reported that the PED type, n-AMD subtype, baseline PED height, and anti-VEGF drug type were associated with the probability of PED resolution after anti-VEGF treatment [ 24 ].…”

Livelayer: A Semi-Automatic Software Program for Segmentation of Layers and Diabetic Macular Edema in Optical Coherence Tomography Images

“…There are different types of fluids with regard to their position. Intra-Retinal Fluid (IRF) normally appears above Outer Plexiform Layer (OPL), Sub-Retinal Fluid (SRF) is dark accumulations of fluid beneath the Outer Segment Layer (OSL) [20] and Pigment Epithelial Detachments (PEDs) are related to a condition where the Retinal Pigment Epithelium (RPE) detaches from Bruch's Membrane due to the buildup of fluid or blood between these layers [21]. In this section, we have employed two distinct techniques to locate all kinds of fluids (Fig.…”

Aflibercept for Vascularised Serous Pigment Epithelial Detachment: One-Year Anatomical and Functional Results

“…Jako jedinou, v současné době schválenou léčbou dle SPC, je intravitreální anti-VEGF terapie. Dle probíhajících studií se dále jeví jako účinná kombinace fotodynamické terapie a anti-VEGF [9].…”