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Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology 9/2012

01.09.2012 | Retinal Disorders

Vascularized retinal pigment epithelial detachment in age-related macular degeneration: treatment and RPE tear incidence

verfasst von: Ugo Introini, Ana Torres Gimeno, Fabrizio Scotti, Marco Setaccioli, Silvia Giatsidis, Francesco Bandello

Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology | Ausgabe 9/2012

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Abstract

Background

To review vascularized-pigment epithelial detachment (V-PED) treatment visual outcome, and to assess acute retinal pigment epithelium (RPE) tear incidence.

Methods

One hundred and thirty-two eyes of 125 consecutive patients with age-related macular degeneration and V-PED were included. Ninety-four eyes (71.2%) were associated with choroidal new vessels (CNV), 38 (28.8%) with retinal angiomatous proliferation (RAP). Patients, treated over a 10-year period with the time-current therapy, received: verteporfin photodynamic therapy (PDT) (group 1, 38 eyes), combined intravitreal triamcinolone acetonide (IVTA) and PDT (group 2, 44 eyes) or intravitreal anti-VEGF injection (bevacizumab or ranibizumab) (group 3, 50 eyes).

Results

Mean follow-up was 20.5 months. At month 12, all eyes treated with PDT or with IVTA and PDT showed a mean significant severe visual decrease. Eyes with CNV lost −0.67 and −0.37 logMAR (p < 0.01 and p < 0.01 respectively), and eyes with RAP −0.55 and −0.31 logMAR (p < 0.01 and p = 0.01 respectively). RPE tear occurred in 14 eyes (36.8%) and in six eyes (13.6%) in groups 1 and 2 respectively. Eyes treated with anti-VEGF therapy showed slight mean visual acuity decrease at month 12. Those with CNV had a mean baseline best-corrected visual acuity (BCVA) of 0.36 ± 0.24 logMAR, final of 0.44 ± 0.30 logMAR (−0.08 logMAR, n.s.). In eyes with RAP, mean baseline BCVA was 0.58 ± 0.39 logMAR, final was 0.78 ± 0.47 logMAR (−0.20 logMAR, n.s.). RPE tear occurred in 14 eyes (36.8%). Patients with either V-PED with CNV or a better baseline BCVA showed greater risk of acute RPE tear (p = 0.01 and p = 0.003 respectively).

Conclusions

Effective treatment for vascularized PED is still lacking. Until now, only stabilization of the disease has been achieved using anti-VEGF therapy, but the risk of RPE tear can further hamper our expectations. Baseline characteristics are helpful for prognosis, but patients must be informed of the uncertain response. New therapeutic strategies are needed.
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Metadaten
Titel
Vascularized retinal pigment epithelial detachment in age-related macular degeneration: treatment and RPE tear incidence
verfasst von
Ugo Introini
Ana Torres Gimeno
Fabrizio Scotti
Marco Setaccioli
Silvia Giatsidis
Francesco Bandello
Publikationsdatum
01.09.2012
Verlag
Springer-Verlag
Erschienen in
Graefe's Archive for Clinical and Experimental Ophthalmology / Ausgabe 9/2012
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-012-1955-2

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