Abstract

DO.10.11

Anti-VEGF therapy – a central challenge in medical retina

Pauleikhoff D.
Augenabteilung am St. Franziskus Hospital Münster

Objective: The efficacy of new Anti-VEGF therapies have been demonstrated in prospective clinical trials. This has changed the treatment concepts in exudative AMD. But the transfer into clinical praxis is associated with central challenges in order to generate the best possible clinical outcome for our patients. Especially the parameters for retreatments and the end of the treatment as well as the characterisation of the inidividual visual prognosis has to be defined.
Methods: In order to adress these questions 500 consecutive patients with exudative AMD were observed after Anti-VEGF therapy. Different parameters (visual acuity, sensitivity of the retina in microperimetry, retinal edema in OCT, RPE-integrity in autofluorescence, activity of the CNV in fluoresceine angiography) were recorded and the efficacy of an individual adapted retreatment scheme (visual loss, increased retinal thickness, new activity in FA or new retnal blood) has been analized.
Results: Anti-VEGF therapies are primary anti-permeability treatments and the treatment effect (increased or stabilized visual acuity) is visible allready after the initial three injections. The treatment resulted in a general decrease in foveal retinal thickness. Butt he funtional effect of this was very different and was dependent of prexisting morphological and structural changes in the fovea. This damage was gradually be visible by the initial foveal AF. Only if this AF was unchanged, an increase in visual acuity could be observed. Furthermore during longer follow up after different time intervalls and number of injections a fibrovascular transfer of the CNV was visible (mean number of injections 4.5). Also the time intervall of „reactivation“ of the CNV after intial stabilisation was very different and varied individualy within a large range.
Conclusions: In general the Anti-VEGF therapy in exudative MD is a very effective new treatment procedure. The individual visual respone depends on the initial structural situation of the central retina and RPE. Only if these structures are unchanged, the reduction in macular thickness was associated with an incease in visual function. In addition the duration of therapy as well as the number and time intervall of injections is individually very different and can only be judged during close follow-up examinations (p.e. every 4-6 weeks during the first year).

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