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CC BY-NC-ND 4.0 · Klin Monbl Augenheilkd 2024; 241(04): 453-458
DOI: 10.1055/a-2248-9986
Klinische Studie

Long-term Follow-Up and Regeneration of Retinal Pigment Epithelium (RPE) after Tears of the Epithelium in Exudative Age-Related Macular Degeneration (AMD)

Langzeit Follow-up und Regeneration des retinalen Pigmentepithels (RPE) nach Rupturen des retinalen Pigmentepithels bei exsudativer altersbedingter Makuladegeneration (AMD)
Nicolas Skalicky 
1   Vista Eye Clinic, Binningen, Switzerland
,
Katja Hatz-Wurziger
1   Vista Eye Clinic, Binningen, Switzerland
2   University of Basel, Faculty of Medicine, Basel, Switzerland
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Abstract

Background The goals of this study are to evaluate potential long-term visual deterioration associated with retinal pigment epithelial (RPE) tears in patients with neovascular age-related macular degeneration (nAMD) and to find treatment-related and morphological factors that might influence the outcomes.

Patients and Methods This retrospective study enrolled 21 eyes of 21 patients from the database of Vista Eye Clinic Binningen, Switzerland, diagnosed with RPE tears, as confirmed by spectral domain optical coherence tomography (SD-OCT), with a minimum follow-up period of 12 months. Treatment history before and after RPE rupture with anti-VEGF therapy, visual acuity, and imaging (SD-OCT) were analyzed and statistically evaluated for possible correlations.

Results Mean patient age was 80.5 ± 6.2 years. The mean length of total follow-up was 39.7 ± 13.9 months. The mean pigment epithelial detachment (PED) height increased by 363.8 ± 355.5 µm from the first consultation to 562.8 ± 251.5 µm at the last consultation prior to rupture. Therefore, a higher risk of RPE rupture is implied as a result of an increase in PED height (p = 0.004, n = 14). The mean visual acuity before rupture was 66.2 ± 16.0 letters. Mean visual acuity deteriorated to 60.8 ± 18.6 letters at the first consultation after rupture (p = 0.052, n = 21). A statistically nonsignificant decrease in vision was noted in the follow-up period. After 2 years, the mean BCVA decreased by 10.5 ± 23.7 ETDRS letters (p = 0.23, n = 19). PED characteristics before rupture and amount of anti-VEGF injections after rupture did not affect the visual outcome. None of the 21 patients included in our study showed a visual improvement in the long-term follow-up. RPE atrophy increased significantly from 3.35 ± 2.94 mm2 (baseline) to 6.81 ± 6.25 mm2 over the course of 2 years (p = 0.000 013, n = 20).

Conclusions The overall mean vision decrease after rupture was without statistical significance. There was no significant change in BCVA at the 2-year follow-up, independent of the amount of anti-VEGF injections provided. In this study, there was a significant increase in RPE defect over a follow-up of 2 years, implying progression of contraction of RPE and/or macular atrophy.

Zusammenfassung

Hintergrund Ziel der Studie war es, die langfristige Sehverschlechterung bei Rupturen des retinalen Pigmentepithels (RPE) bei Patienten mit exsudativer altersbedingter Makuladegeneration (AMD) zu untersuchen und behandlungsbedingte und morphologische Faktoren zu ermitteln, die die Visusprognose beeinflussen können.

Patienten und Methoden In diese retrospektive Studie wurden 21 Augen von 21 Patienten aus der Datenbank der Vista Augenklinik Binningen, Schweiz, aufgenommen, bei denen mittels optischer Kohärenztomografie (SD-OCT) eine Ruptur des RPE diagnostiziert wurde und eine Follow-up-Periode von mindestens 12 Monaten bestand. Der Behandlungsverlauf vor und nach der RPE-Ruptur mit Anti-VEGF-Injektionen, die Sehschärfe und bildgebende Verfahren (SD-OCT) wurden analysiert und auf mögliche Korrelationen untersucht.

Ergebnisse Das Durchschnittsalter der Patienten betrug 80,5 ± 6,2 Jahre. Die durchschnittliche Dauer der Nachbeobachtung betrug 39,7 ± 13,9 Monate. Die mittlere Zunahme der PED-Höhe lag bei 363,8 ± 355,5 µm von der ersten Konsultation auf 562,8 ± 251,5 µm bei der letzten Konsultation vor dem Auftreten der Ruptur. Entsprechend kann ein höheres Risiko einer RPE-Ruptur als Folge einer Zunahme der PED-Höhe mit statistischer Signifikanz nachgewiesen werden (p = 0,004, n = 14). Die mittlere Sehschärfe vor der Ruptur lag bei 66,2 ± 16,0 ETDRS-Letters. Eine Verschlechterung bei der ersten Konsultation nach der Ruptur auf 60,8 ± 18,6 ETDRS-Letters konnte gemessen werden (p = 0,052, n = 21). In der Nachbeobachtungszeit konnte eine weitere statistisch nicht signifikante Abnahme der Sehkraft festgestellt werden. Innerhalb von 2 Jahren nahm der mittlere korrigierte Visus um 10,5 ± 23,7 ETDRS-Letters ab (p = 0,23, n = 19). Die Charakteristika der PED vor der Ruptur und die Menge der nach der Ruptur verabreichten Anti-VEGF-Injektionen hatten keinen Einfluss auf die Visusprognose. Keiner der 21 Patienten, die in unsere Studie aufgenommen wurden, zeigte in der langfristigen Nachbeobachtung eine Sehverbesserung. Die RPE-Atrophie vergrößerte sich jedoch statistisch signifikant von 3,35 ± 2,94 mm2 (Baseline) auf 6,81 ± 6,25 mm2 im Laufe von 2 Jahren (p = 0,000 013, n = 20).

Schlussfolgerungen Der Mittelwert des Sehvermögens nahm nach der Ruptur ab. Auch in der Nachbeobachtungszeit bis zu 2 Jahren konnte ein weiterer nicht signifikanter Trend zur Abnahme des mittleren korrigierten Visus festgestellt werden, unabhängig von der Anzahl der verabreichten Anti-VEGF-Injektionen. In unserer Studie wurde ein signifikanter Anstieg des RPE-Defekts über einen Nachbeobachtungszeitraum von 2 Jahren festgestellt, was auf eine fortschreitende Kontraktion des RPE und/oder eine Makulaatrophie schließen lässt.

Keywords

retinal pigment epithelial tears - regeneration of retinal pigment epithelial tears - risk factors for retinal pigment epithelial tears - prognostic factors in retinal pigment epithelial tears

Schlüsselwörter

Rupturen des retinalen Pigmentepithels - Regeneration des retinalen Pigmentepithels - Risikofaktoren für Rupturen des retinalen Pigmentepithels - prognostische Faktoren nach Rupturen des retinalen Pigmentepithels


Publication History

Received: 24 October 2023

Accepted: 21 December 2023

Article published online:
14 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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