Haemorheopheresis could block the progression of the dry form of age-related macular degeneration with soft drusen to the neovascular form

Abstract

ABSTRACT.Purpose: To evaluate the influence of haemorheopheresis on anatomical and functional findings in patients with soft-drusen maculopathy. Methods: We investigated 29 eyes (16 patients) and randomized 25 eyes (16 controls) with soft-drusen maculopathy [soft, confluent and reticular drusen, drusenoid retinal pigment epithelium detachment (RPED)]. Each patient received a series of eight haemorheophereses (cascade filtration of 1.5 plasma volume) within 10 weeks. The patients were followed up using Early Treatment Diabetic Retinopathy Study (ETDRS) charts, optical coherence tomography, fluorescein angiography, electroretinography and measurements of pulsed ocular blood flow. Results: After the procedures, there was a substantial reduction in rheologically active substances [lipoproteins, immunoglobulin M (IgM), fibrinogen], plasma and blood viscosity. At the 1.5-year follow-up, we noticed soft drusen absorption; reattachment of drusenoid RPED and stabilization or improvement of visual acuity occurred in 72% of patients in comparison to only 39% of patients in the control group. Full-field electroretinograms showed significantly higher scotopic activity of treated patients in comparison with the control group, and mainly insignificant differences in photopic activity between both groups. Despite the significant increase of activity in the paramacular retina in treated patients, the differences in amplitudes of multifocal electroretinography (mfERG) average responses were insignificant between groups. Conclusion: Haemorheopheresis seems to be capable of changing the activity of promoters of the natural course of soft-drusen maculopathy, its development and progression. Visual acuity and electrical activity of the retina can be stabilized or even improved. The therapy has been shown to be effective and safe.

Changes of the complement system and rheological indicators after therapy with rheohemapheresis

“…According to Schwartz et al, 2013 (Writing Committee of the American Society for Apheresis), two controlled trials and five completed randomized controlled trials reporting on rheopheresis efficacy in treatment of dry AMD have been published, in addition to case reports [26]. Among them, our randomized study is also mentioned [8]. Based on these positive results, the American Society for Hemapheresis reassigned dry AMD to the first line indications in their regularly updated guidelines (last issued in 2013) e "Disorders for which apheresis is accepted as first line therapy" [26].…”

Long-Term Outcomes of Rheohaemapheresis in the Treatment of Dry Form of Age-Related Macular Degeneration

“…In our earlier study, we used the Reconstruct Programme for the geometric comparison of the DPED area [8]. However, the programme has some disadvantages.…”

Dynamics of Blood Count after Rheohemapheresis in Age-Related Macular Degeneration: Possible Association with Clinical Changes

“…The activity changes are time-dependent. Currently, we hypothesize that RHF favorably influences several clinical changes, including vision [10], and favorably influences the pathways of complement activation and H protein regulation. Indeed, the first results showed the decreasing activity of several complement components after rheohemapheresis (data unpublished).…”

“…Every patient was treated with a series of 8 RHF procedures over 10 weeks (twice, every other day, in the first week, followed by 2 weeks rest period and repeated again 4 times). The procedures used have been previously described elsewhere [8–10]. …”

“…The aim of the therapy is to stop the progression of the disease. In several cases, we observed certain improvements, such as the disappearance of the drusen or a reduction of thedrusenoid retinal pigment epithelium detachment (DPED) area [8–10]. …”