Serous pigment epithelial detachment in age-related macular degeneration: comparison of different treatments

Abstract

Aims To investigate the therapeutic effects of different treatments on serous pigment epithelium detachment (PED) in age-related macular degeneration (AMD). Methods A total of 328 patients suffering from serous PED in AMD were retrospectively analysed. We treated only patients with documented visual deterioration: 86 patients with bevacizumab, 128 with ranibizumab, 60 with pegaptanib, and 54 with photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide (IVTA). Bestcorrected vision was determined in the logarithm of the minimal angle of resolution (logMAR). We also analysed morphological findings such as full foveal thickness by optical coherence tomography (OCT), manually calculated height of PED as measured by OCT, and fluorescence angiography. Results The mean follow-up was 42.4 weeks. The best-corrected visual acuity of 0.78 logMAR before treatment could be improved by about 0.066 logMAR after treatment. Retinal thickness decreased in all patients with PED, in the mean by about 64.06 lm, and the mean value of the manually calculated height decreased by about 0.98 units. All functional and morphological results proved to be significantly better after injection of ranibizumab and bevacizumab than after pegaptanib and the combined treatment with PDT and IVTA. In all, 41 (12.5%) of our patients developed a tear of the retinal pigment epithelium (RPE). Conclusion The therapeutic results were significantly better in patients treated with bevacizumab and ranibizumab than in those treated with pegaptanib or with a combination of PDT and IVTA. Even with treatment, tears of the RPE or only a partial flattening of the PED always indicated a worse prognosis in eyes with exudative AMD than in eyes with classic choroidal neovascularization.

Long-term visual outcome of pigment epithelial tears in association with anti-VEGF therapy of pigment epithelial detachment in AMD

“…20,26,27 This incidence is similar to that reported for the natural history of untreated PED. 4,5 However, in both the published literature and the present study these RPE tears always developed relatively close to the time when the anti-VEGF therapy was started ).…”

One-year outcome after intravitreal ranibizumab for large, serous pigment epithelial detachment secondary to age-related macular degeneration

“…In the studies by Ritter et al 5 and Lommatzsch et al, 6 the incidence of RPE rip varied from 8 to 12%, respectively. Chiang et al 7 have reported large PED basal diameter and vertical height of PED to be the predictors of increased risk of RPE rip (17%) in eyes (60 eyes) treated with anti VEGF (ranibizumab, bevacizumab, and pegaptanib).…”

Grid laser photocoagulation in the treatment of serous avascular pigment epithelial detachment in age-related macular degeneration

“…When comparing these traditional therapeutic modalities administered to 328 patients with serous PED, excluding laser photocoagulation, the best results were obtained with the anti-angiogenic drugs bevacizumab and ranibizumab. The study concluded that the partial flattening was more significant with these drugs than with pegaptanib or photodynamic therapy combined with intravitreal triancinolone (28) . In this study it was assumed that the neovascular or fibrovascular component exhibits a physiopathology different from that of strictly serous or avascular cases, in which there is no thickening of the tissue underlying the RPE or the presence of fluid above the pigment epithelium or inside the neurosensory retina.…”

“…Considering that these tears occur spontaneously after anti-angiogenic treatment, photodynamic therapy and thermal laser, we opted for laser application despite the risks of this procedure (28) . One year after treatment with mild macular grid laser there was a reduction in the number and size of drusen adjacent to the photocoagulated areas.…”