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

Abstract

Purpose. Determining long-term effects of rheohaemapheresis on the dry form of age-related macular degeneration. Methods. This study evaluates 19 patients, average age of 67.6 years, treated with rheohaemapheresis and 18 patients, average age of 72.8 years, comprising the control group. Minimum follow up period was 3.5 years. Each treated patient received a series of 8 sessions of rheohaemapheresis of 1.5 plasma volumes within 10 weeks. We measured the drusenoid pigment epithelium detachment (DPED), best-corrected visual acuity (BCVA), electroretinography (ERG), and rheological parameters. Results. In the treatment group, the baseline BCVA was 0.74 (0.36–1.0) 95% CI and BCVA after 3.5 years was 0.79 (0.41–1.0) 95% CI (P = 0.726). In the control group, the baseline BCVA was 0.71 (0.15–1.0) 95% CI and BCVA after 3.5 years decreased to 0.7 (0.32–0.87) 95% CI (P = 0.031). Baseline DPED was 6.78 ± 3.79 mm2; after 3.5 years, it decreased to 4.13 ± 3.84 mm2 (P < 0.001). In the control group, the baseline DPED was 4.09 ± 3.48 mm2; after 3.5 years, it increased to 6.69 ± 4.2 mm2 (P = 0.001). We noted increasing levels of positive wave peaking at 50 milliseconds (P50) after treatment (P = 0.022) and a stable amplitude of photopic responses of treated patients. Conclusion. Over the long term, rheohaemapheresis reduced the DPED, improved the function of photoreceptors, and prevented the decline of BCVA.

The Impact of Rheohaemapheresis on the Proprotein Convertase Subtilisin Kexin 9 (PCSK9) in Age-Related Macular Degeneration

“…We have shown in the present study, that the treatment of the in patients with advanced dry AMD by rheohaemapheresis resulted in the BCVA improvement during long-term follow up. These results con rmed our previous ndings, where we demonstrated improved BCVA in the group of treated patients and statistically signi cant deterioration in the control group of patients [26]. Similar results published the authors of the MAC-I study from the University of Cologne, MAC-II study from the University of Frankfurt, and MAC-III study from the University of Hamburg [19].…”

“…The procedures were performed from the peripheral vein in the elbow pit or in the forearm. We presented some more detailed data separately [24][25][26]. The treatment scheme was performed for patients with AMD according to the MIRA-1 study [27]; 8 procedures in 10 weeks, i.e.…”

“…The effects of a successful treatment last from 2 to 2.5 years usually, according to our experience. It is recommended (based on the literature data and our experience [19,26] that 1-2 additional procedures are performed to boost the effect ("booster therapy") after this 2-year period. For our group of patients, we decided on 2 procedures within 1 week.…”

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

“…The flow of plasma is continual, anticoagulation is ensured with heparin and ACD; the basic amount of processed plasma e one and a half times body volume e is calculated by the blood cell separator computer. The procedures used have been previously described elsewhere [9,10,18]. The patients with AMD underwent 8 rheohemapheretic procedures within 10 weeks while the patients with acute hearing loss underwent 3 procedures within one week.…”

Preservation of the Photoreceptor Inner/Outer Segment Junction in Dry Age-Related Macular Degeneration Treated by Rheohemapheresis

“…So far, 61 patients with the dry form of AMD, soft drusen, confluent soft drusen, and drusenoid pigment epithelium detachment (DPED) have been treated. We perform long-term monitoring of morphological and functional changes in the retina [ 12 , 13 ].…”