Artikel
Prognostische Faktoren bei der Anti-VEGF-Therapie der exsudativen AMD
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Veröffentlicht: | 18. Juni 2008 |
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Purpose: Anti-VEGF-therapy with Ranibizumab has been shown to be an effective treatment for specific types of exudative AMD, but a clinical distinction between patients likely to have improved visual acuity (VA) and less favourable visual outcome is not possible. RPE-autofluorescence (AF) has been demonstrated as indicator for RPE function and microperimetry as indicator for photoreceptor function. The aim of present prospective study was to test these two techniques as prognostic parameters in anti-VEGF therapy.
Methods: 180 patients (102 f, 78 m; mean age 74y.) were treated three times with Ranibizumab (4 weeks intervals). AF images were obtained with HRA 2 and the central RPE-AF within 250 µm around the foveola analyzed (normal AF in 98 eyes vs changed AF in 82 eyes). In addition miroperimetry (MP), VA and retinal thickness (OCT) was analyzed.
Results: Before treatment VA was similar between AF groups (p=.3), but after treatment (3 mo) a significant difference existed (p=.004; normal AF: increased VA 84%, changed AF: increased VA 25.8%, p<.0001) despite a similiar reduction in retinal thickness in both groups (p=0.6). When divided according to MP foveal sensitivity (below vs above 4dB) the VA was also similar before therapy (p=0.1), but after 3 mo despite similar reduction in retinal thickness (75µm vs 120µm; p=.2) a significant difference in VA between both groups was found (p=.002). Combining both parameters increased differences were found .
Conclusions: The results of this study demonstrate that despite similar reduction in retinal thickness, the analysis of foveal RPE-AF and foveal retinal sensitivity are significant prognostic factor to determine the functional outcome after anti-VEGF therapy in AMD.