Response of Pigment Epithelial Detachment to Three-Loading-Dose of Intravitreal Anti-Vascular Endothelial Growth Factor in Neovascular Age-Related Macular Degeneration

Yıl 2023, Cilt: 6 Sayı: 3, 421 - 425, 31.12.2023

Ayna Sariyeva Ismayilov , Cansu Erseven , Kevser Koyuncu , Mahmut Oğuz Ulusoy

https://doi.org/10.36516/jocass.1346130

Öz

Objective: Response of pigment epithelial detachment (PED) to three loading dose of intravitreal bevacizumab (IVB) treatment in neovascular age-related macular degeneration (nAMD) cases.
Methods: OCT findings (PED height (µm), diameter(µm) and area (mm²), central macular thickness (CMT), central choroidal thickness (CCT), intraretinal fluid (IRF), subretinal fluid (SRF)), and morphological features of macular neovascularization (MNV) in OCTA before and after three loading doses of IVB were examined and compared.
Results: Forty-two eyes of 42 naive nAMD patients with PED were included. Fifteen patients had serous and 27 patients had fibrovascular PED. After three loading doses, best corrected visual acuity (BCVA) (in Snellen) increased from 0.22±0.19 to 0.29±0.22 (p<0.001). The mean PED height, width and area decreased (323.46±189.80 µm,274.79±199.80 µm, p=0.007; 1639.87±1037.44 µm, 1599.01±993.88 µm, p=0.138; 2.90±2.76 mm², 2.24±2.38 mm², p=0.038 respectively). CMT decreased from 500.34±286.62 µm to 366.14±238.10 µm, CCT decreased from 251.55±74.44 µm to 197.09±50.36 (p<0.001 for both). IRF or SRF were significantly regressed (p=0.008 and p=0.032). Branching decreased from 23.8% of patients to 11.9% (p=0.044), loops completely regressed (p<0.001), hypointense halo decreased from 7.1% of patients to 4.6% (p=0.323), open circulation decreased from 23.8% to 4.6% (p<0.001). Seafan and medusa NV were present in 2.3% and 4.6% of patients, however did not differ. The pruned tree NV increased from 11.9% to 33.3% (p<0.001). Closed circulation increased from 33.3% to 38% (p=0.083).
Discussion: After three loading doses of IVB, PED height and area were significantly reduced and also 21.4% of PED completely regressed and 52.3% of PED decreased. MNV with PED, particularly brancing, loops had regressed, and most of the pruned tree formations were increased and some of the open circulations were converted to closed circulation. In conclusion, 3 loading doses IVB decreased the size a half of PEDs and changed feature of MNVs with PED.

Anahtar Kelimeler

pigment epithelial detachment, neovascular age-related macular degeneration, optical coherence tomography, optical coherence tomography angiography

Neovasküler Yaşa Bağlı Makula Dejenerasyonunda Bulunan Pigment Epitel Dekolmanının Üç Yükleme Dozu İntravitreal Anti-Vasküler Endotelyal Büyüme Faktörüne Yanıtı

Öz

Giriş: Neovasküler yaşa bağlı makula dejenerasyonu (nAMD) olgularında pigment epitel dekolmanının (PED) üç yükleme dozu intravitreal bevacizumab (İVB) tedavisine yanıtının incelenmesi.
Yöntem: OKT bulguları (PED yüksekliği, çapı ve alanı, merkezi makula kalınlığı (MMK), merkezi koroidal kalınlık (MKK), intraretinal sıvı (IRS), subretinal sıvı (SRS)) ve OKTA'da makuler neovaskülarizasyonun (MNV) morfolojik özellikleri İVB'nin üç yükleme dozundan önce ve sonra incelendi ve karşılaştırıldı.
Sonuç: PED'li 42 naif nAMD hastasının 42 gözü dahil edildi. Onbeş hastada seröz ve 27 hastada fibrovasküler PED vardı. Üç yükleme dozundan sonra en iyi düzeltilmiş görme keskinliği (EİDGK) (Snellen'de) 0,22±0,19'dan 0,29±0,22'ye yükseldi (p<0,001). Ortalama PED yüksekliği, genişliği ve alanı azaldı (323,46±189,80 µm,274,79±199,80 µm, p=0,007; 1639,87±1037,44 µm, 1599,01±993,88 µm, p=0,138; 2,90±2,76 mm², 2,24±2,38 mm², p= sırasıyla 0.038). MMK 500,34±286,62 µm'den 366,14±238,10 µm'ye, MKK 251,55±74,44 µm'den 197,09±50,36'ya düştü (her ikisi için p<0,001). IRS veya SRS anlamlı olarak geriledi (p=0,008 ve p=0,032). Dallanma şeklindeki NV, hastaların %23,8'inden %11,9'una (p=0,044), loops tamamen geriledi (p<0,001), hipointens halo hastaların %7,1'inden %4,6'sına (p=0,323), açık dolaşım %23,8'den 4,6'ya düştü % (p<0.001). Seafan ve medusa NV hastaların %2,3'ünde ve %4,6'sında mevcuttu ancak sebaat etti. Budanmış ağaç NV %11,9'dan %33,3'e yükseldi (p<0,001). Kapalı dolaşım %33,3'ten %38'e yükseldi (p=0,083).
Tartışma: Üç yükleme dozu İVB sonra, PED yüksekliği ve alanı anlamlı olarak azaldı ve ayrıca PED’lerin %21,4’ü tamamen geriledi ve %52.3’ü küçüldü. MNV’laradan, özellikle dallanma, loops geriledi ve budanan ağaç formasyonu arttı ve açık sirkülasyonların bir kısmı kapalı sirkülasyona dönüştü. Sonuç olarak, üç yükleme dozu IVB, PED'lerin yarısına etki ederek boyutunu küçülttü ve MNV'lerin morfolojik özelliklerini değiştirdi.

Kaynakça

• 1.Zayit-Soudry S, Moroz I. Loewenstein A Retinal pigment epithelial detachment. Surv Ophthalmol. 2007; 52(3): 227-43. https://doi.org/10.1016/j.survophthal.2007.02.008
• 2.Au A, Parikh VS, Singh RP, et al. Comparison of anti-VEGF therapies on fibrovascular pigment epithelial detachments in age-related macular degeneration. Br J Ophthalmol. 2017; 101(7): 970-5. https://doi.org/10.1136/bjophthalmol-2016-309434
• 3.Fox SB, Generali DG, Harris AL. Breast tumour angiogenesis. Breast Cancer Res. 2007; 216: 9. https://doi.org/10.1186/bcr1796
• 4.Herbst RS, Ansari R, Bustin F, et al. Efficacy of bevacizumab plus erlotinib versus erlotinib alone in advanced non-small-cell lung cancer after failure of standard first-line chemotherapy (BeTa): a double-blind, placebo-controlled, phase 3 trial. Lancet. 2011; 28; 377: 1846-54. https://doi.org/10.1016/S0140-6736(11)60545-X
• 5.Avery RL, Pieramici DJ, Rabena MD, et al. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology. 2006; 113: 363-72. https://doi.org/10.1016/j.ophtha.2005.11.019
• 6.Lazic R, Gabric N. Intravitreally administered bevacizumab (Avastin) in minimally classic and occult choroidal neovascularization secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2007; 245: 68-73. https://doi.org/10.1007/s00417-006-0466-4
• 7.Moult E, Choi W, Waheed NK, et al. Ultrahigh-speed swept-source OCT angiography in exudative AMD. Ophthalmic Surg Lasers Imaging Retina. 2014; 45: 496-505. https://doi.org/10.3928/23258160-20141118-03
• 8.Costanzo E, Miere A, Querques G, et al. Type 1 choroidal neovascularization lesion size: indocyanine green angiography versus optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2016; 57: 307-13. https://doi.org/10.1167/iovs.15-18830
• 9.Khanani AM, Eichenbaum D, Schlottmann PG, et al. Optimal management of pigment epithelial detachments in eyes with neovsacular age-related macular degeneration. Retina. 2018; 38(11): 2103-117. https://doi.org/10.1097/IAE.0000000000002195
• 10.Schmidt-Erfurth U, Waldstein SM, Deak GG, et al. Pigment epithelial detachment followed by retinal cystoid degeneration leads to vision loss in treatment of neovascular age-related macular degeneration. Ophthalmology. 2015; 122(4): 822-32. https://doi.org/10.1016/j.ophtha.2014.11.017
• 11.Arora S, McKibbin M. One-year outcome after intravitreal ranibizumab for large, serous pigment epithelial detachment secondary to age-related macular degeneration. Eye. 2011; 25: 1034-8. https://doi.org/10.1038/eye.2011.115
• 12.Freeman WR, Kozak I, Yuson RM, et al. Prognostic implications of pigment epithelial detachment in bevacizumab(avastin)-treated eyes with age-related maculardegeneration and choroidal neovascularization. Retina. 2011 ;31(9): 1812-8. https://doi.org/10.1097/IAE.0b013e31821987a4
• 13.Chen E, Kaiser RS, Vander JF. Intravitreal bevacizumab for refractory pigment epithelial detachment with occult choroidal neovascularization in age-related macular degeneration. Retina. 2007; 27: 445-50. https://doi.org/10.1097/01.iae.0000249574.89437.40
• 14.Ulusoy MO, Kal A, Yilmaz G. Comparison of the effects of anti-vascular endothelial growth factor treatments on pigment epithelial detachment in age-related macular degeneration. Int Ophthalmol. 2021; 41(4): 1363-72. https://doi.org/10.1007/s10792-021-01695-3
• 15.Coscas GJ, Lupidi M, Coscas F, et al. Optical coherence tomography angiography versus traditional multimodal imaging in assessing the activity of exudative age-related macular degeneration: a new diagnostic challenge. Retina. 2015; 35: 2219-28. https://doi.org/10.1097/IAE.0000000000000766
• 16.Kuehlewein L, Bansal M, Lenis TL, et al. Optical coherence tomography angiography of type 1 neovascularization in age-related macular degeneration. Am J Ophthalmol. 2015; 160: 739-48. https://doi.org/10.1016/j.ajo.2015.06.030
• 17.Lupidi M, Cerquaglia A, Chhablani J, et al. Optical coherence tomography angiography in age-related macular degeneration: the game changer. Eur J Ophthalmol. 2018; 28: 349-57. https://doi.org/10.1177/1120672118766807
• 18.Bae K, Kim HJ, Shin YK, et al. Predictors of neovascular activity during neovascular age-related macular degeneration treatment based on optical coherence tomography angiography. Sci Rep. 2019; 17; 9(1): 19240. https://doi.org/10.1038/s41598-019-55871-8
• 19.Pauleikhoff D, Loffert D, Spital G, et al. Pigment epithelial detachment in the elderly: clinical differentiation, natural course and pathogenetic implications. Graefes Arch Clin Exp Ophthalmol. 2002; 240: 533-8. https://doi.org/10.1007/s00417-002-0505-8
• 20.Shima C, Gomi F, Sawa M, et al. One-year results of combined photodynamic therapy and intravitreal bevacizumab injection for retinal pigment epithelial detachment secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2009; 247(7): 899-906. https://doi.org/10.1007/s00417-009-1067-9
• 21.Axer-Siegel R, Ehrlich R, Rosenblatt I, et al. Photodynamic therapy for occult choroidal neovascularization with pigment epithelium detachment in age-related macular degeneration. Arch Ophthalmol. 2004; 122:453-9. https://doi.org/10.1001/archopht.122.4.453
• 22.Bolz M, Michels S, Geitzenauer W, et al. Effect of systemic bevacizumab therapy on retinal pigment epithelial detachment. Br J Ophthalmol. 2006; 91: 785-9. https://doi.org/10.1136/bjo.2006.102467
• 23.Abi-Ayad N, Mauget-Faysse M, Amara-Allieu S, et al. Systemic Bevacizumab for Retinal Angiomatous Proliferation Associated with Retinal Pigment Epithelial Detachment. European Journal of Ophthalmology 2007; 17(6): 987-91. https://doi.org/10.1177/112067210701700621
• 24.Javaheri M, Hill L, Ghanekar A, et al. Changes in Treatment-Naive Pigment Epithelial Detachments Associated With the Initial Anti-Vascular Endothelial Growth Factor Injection: A Post Hoc Analysis From the HARBOR Trial. JAMA Ophthalmol. 2021; 139(2): 219-23. https://doi.org/10.1001/jamaophthalmol.2020.5130
• 25.Ach T, Hoeh AE, Ruppenstein M, et al. Intravitreal bevacizumab in vascular pigment epithelium detachment as a result of subfoveal occult choroidal neovascularization in age-related macular degeneration. Retina. 2010; 30(9): 1420-5. https://doi.org/10.1097/IAE.0b013e3181d87e97
• 26.Cho HJ, Kim KM, Kim HS, et al. Response of Pigment Epithelial Detachment to Anti-Vascular Endothelial Growth Factor Treatment in Age-Related Macular Degeneration. Am J Ophthalmol. 2016; 166: 112-9. https://doi.org/10.1016/j.ajo.2016.03.039
• 27.Tan ACS, Freund KB, Balaratnasingam C, et al. Imaging of pigment epithelial detachments with optical coherence tomography angiography. Retina. 2018; 38(9): 1759-69. https://doi.org/10.1097/IAE.0000000000002016