Influence of Macular Morphology on the Individualization of the Treatment Protocol of Wet Age-related Macular Degeneration

Wydanie 2/2018
str. 26 – 30

Autorzy: Ewa Wasiluk, Małgorzata Wojnar, Dorota Ługowska

Klinika Okulistyki Uniwersyteckiego Szpitala Klinicznego w Białymstoku
Kierownik: prof. dr hab. n. med. Zofia Mariak

Summary: The aim of the study is to assess the characteristic morphological features of the retina, which may affect the response to the treatment of neovascular age-related macular degeneration.

We conducted a systematic search using PubMed with the key words: „neovascular AMD”, „choroidal neovascularization” (CNV), anti-vascular endothelial growth factor”, „ranibizumab”, „aflibercept”, „predictive”, „prognostic”, „clinical trials”. We only included prospective studies, covering an adequate number of patients, lasting at least 12 months, with a single predefined treatment regimen and indications for re-injection, without switching from one drug to the other, in which optical coherence tomography was used to assess retinal morphology. The criteria were met by nine studies.

There are several morphological prognostic indicators that can suggest a predicted response to anti-vascular endothelial growth factor therapy at the initial stage, before starting treatment. Positive prognostic indicators are posterior vitreous detachment, subretinal fluid, smaller choroidal neovascular size, retinal angiomatous proliferation and response to therapy at week 12. In case of older patients with larger CNV and the presence of intraretinal cysts, pigment epithelial detachment and vitreomacular adhesion or traction (VMA/VMT), the effects of therapy are usually worse.

Patients having VMA/VMT and patients with pigment epithelial detachment required more injections. In contrast, patients with subretinal fluid and posterior vitreous detachment required less frequent follow-ups.
Evaluation of the morphological features of the patient’s retina prior to initiating anti-vascular endothelial growth factor therapy may contribute to improvement of an individual treatment regimen, allowing the selection of the optimal frequency of follow-ups and re-injections. This may result in better treatment results with fewer burdens for patients and the health system.