Funktionelle und morphologische mikrostrukturelle Veränderungen in der SD-OCT bei der Langzeitbehandlung der neovaskulären AMD mit Ranibizumab-Monotherapie versus Kombinationstherapie mit PDT

Zusammenfassung

Hintergrund: Zur Behandlung der neovaskulären altersabhängigen Makuladegeneration (nAMD) ist die intravitreale Anti-VEGF-Therapie Goldstandard. Inwiefern eine additive photodynamische Therapie (PDT) das funktionelle und strukturelle Ergebnis beeinflussen kann, wird in der Literatur kontrovers diskutiert. Ziel unserer Studie war es, den funktionellen und morphologischen Effekt der Kombinationstherapie mit PDT plus Ranibizumab im Vergleich zur Monotherapie mit Ranibizumab im Langzeitverlauf zu untersuchen.

Material und Methoden: In einer retrospektiven Studie wurden die Daten von Patienten mit nAMD ausgewertet, die für mindestens 42 Monate nachbeobachtet wurden. Patienten wurden der Gruppe A (Monotherapie mit Ranibizumab nach pro re nata [PRN]) oder der Gruppe B (Kombinationstherapie mit einmaliger PDT plus Ranibizumab nach PRN) zugeordnet. Ausgewertet wurden der beste korrigierte Visus (BCVA) zum Start- und Endzeitpunkt sowie die zentrale Retinadicke (CRT), die maximale Retinadicke (MRT) und der Durchmesser der Plaquebasis in der Spectral Domain optischen Kohärenztomografie (SD-OCT) zum 1. Mess- und zum Endzeitpunkt.

Ergebnisse: Eingeschlossen wurden in die Gruppe A 21 Augen (17 Patienten), in die Gruppe B 12 Augen (11 Patienten). Der mittlere Nachbeobachtungszeitraum von Start- bis Endpunkt betrug 64 Monate, von Erstmessung SD-OCT bis Endpunkt 47 Monate. Im Zeitraum zwischen Start- und Endpunkt erhielten die Patienten der Gruppe A 19 ± 14 intravitreale Injektionen, der Gruppe B 22 ± 10. Der BCVA zum Startpunkt betrug in der Gruppe A 0,31 ± 0,26 dezimal, in der Gruppe B 0,31 ± 0,17, zum Endpunkt in der Gruppe A 0,29 ± 0,25 (p = 0,405) und in der Gruppe B 0,25 ± 0,20 (p = 0,142). Die CRT zeigte in der Gruppe A eine Abnahme von 72 ± 178 µm (p = 0,024), in der Gruppe B eine Abnahme von 28 ± 98 (p = 0,1335). Die MRT zeigte analog in der Gruppe A eine Abnahme von 25 ± 135 µm (p = 0,166) und in der Gruppe B eine Abnahme von 2 ± 118 µm (p = 0,421). Die Plaquebasis zeigte eine Zunahme von 32 ± 1468 µm in der Gruppe A (p = 0,242) und 748 ± 1024 in der Gruppe B (p = 0,025).

Schlussfolgerung: Über einen Beobachtungszeitraum von im Mittel 5,3 Jahren zeigten Patienten mit nAMD in beiden Gruppen vergleichbare Ergebnisse mit guter Visusstabilisierung. Es kam in beiden Gruppen tendenziell zu einer Abnahme der Retinadicke sowie zu einer Zunahme der Plaquebasis. Bezüglich der SD-OCT-basierten morphologischen Kriterien zeigten Patienten der Monotherapiegruppe tendenziell ein besseres Therapieansprechen.

Abstract

Background: Intravitreal anti-VEGF therapy is the gold standard in the treatment of neovascular age-related macular degeneration (nAMD). In recent literature, the benefit of additional photodynamic therapy (PDT) has been debated. The aim of our study was to compare the functional and structural effects of long-term combination therapy with PDT plus ranibizumab with monotherapy with ranibizumab.

Material and Methods: In a retrospective study, patients suffering from nAMD were followed up for at least 42 months. Patients were assigned to group A (monotherapy with ranibizumab according to pro re nata [PRN]) or group B (combination therapy with one-time PDT plus ranibizumab according to PRN). The best-corrected visual acuity (BVCA) was evaluated at the starting and end points, together with central retinal thickness (CRT), maximal retinal thickness (MRT) and the maximal diameter of the base of the subretinal plaque in spectral-domain optical coherence tomography (SD-OCT), at the first measurement and at the end point.

Results: Group A consisted of 21 eyes (17 patients) and group B consisted of 12 eyes (11 patients). The average follow-up from starting to end point was 64 months and 47 months, from the first measurement of SD-OCT to the end point. Within this period, patients in group A received 19 ± 14 intravitreal injections, and patients in group B received 22 ± 10 intravitreal injections. BCVA at the starting point was 0.31 ± 0.26 in group A and 0.31 ± 0.17 in group B. At the end point, BCVA in group A was 0.29 ± 0.25 (p = 0.405), and in group B 0.25 ± 0.20 (p = 0.142). CRT decreased in group A by 72 ± 178 µm (p = 0.024) and group B by 28 ± 98 (p = 0.1335). MRT decreased in group A by 25 ± 135 µm (p = 0.166) and in group B by 2 ± 118 µm (p = 0.421). The base of the subretinal plaque increased in group A by 32 ± 1468 µm (p = 0.242) and in group B by 748 ± 1024 (p = 0.025).

Conclusion: In a long-term follow-up of 5.3 years, patients with nAMD in both groups exhibited good stabilisation of visual acuity. In both groups, retinal thickness decreased and the base of the subretinal plaque increased. With respect to SD-OCT morphological criteria, patients in group A (monotherapy) responded slightly better to therapy than patients in group B (combination group).

Schlüsselwörter

AMD - Ranibizumab - photodynamische Therapie

Key words

AMD - ranibizumab - photodynamic therapy

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