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Preservation of the Photoreceptor Inner/Outer Segment Junction in Dry Age-Related Macular Degeneration Treated by Rheohemapheresis.

Rencová E, Bláha M, Studnička J, Bláha V, Lánská M, Renc O, Stepanov A, Kratochvílová V, Langrová H - J Ophthalmol (2015)

Bottom Line: BCVA of treated patients increased insignificantly (P = 0.187) from median 74.0 letters (56.2 to 81.3 letters) to median 79.0 letters (57.3 to 83.4 letters), but it decreased significantly from 74.0 letters (25.2 to 82.6 letters) to 72.5 letters (23.4 to 83.1 letters) in the control group (P = 0.041).The mfERG responses in the region of eccentricity between 1.8° and 7° were significantly higher in treated patients (P = 0.04).Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Lékařská Fakulta, Fakultní Nemocnice, Sokolská 581, 500 09 Hradec Králové, Czech Republic.

ABSTRACT
Aim. To evaluate the long-term effect of rheohemapheresis (RHF) treatment of age-related macular degeneration (AMD) on photoreceptor IS/OS junction status. Methods. In our study, we followed 24 patients with dry AMD and drusenoid retinal pigment epithelium detachment (DPED) for a period of more than 2.5 years. Twelve patients (22 eyes) were treated by RHF and 12 controls (18 eyes) were randomized. The treated group underwent 8 RHF standardized procedures. We evaluated best-corrected visual acuity, IS/OS junction status (SD OCT), and macular function (multifocal electroretinography) at baseline and at 2.5-year follow-up. Results. RHF caused a decrease of whole-blood viscosity/plasma viscosity at about 15/12%. BCVA of treated patients increased insignificantly (P = 0.187) from median 74.0 letters (56.2 to 81.3 letters) to median 79.0 letters (57.3 to 83.4 letters), but it decreased significantly from 74.0 letters (25.2 to 82.6 letters) to 72.5 letters (23.4 to 83.1 letters) in the control group (P = 0.041). The mfERG responses in the region of eccentricity between 1.8° and 7° were significantly higher in treated patients (P = 0.04). Conclusions. RHF contributed to sparing of photoreceptor IS/OS junction integrity in the fovea, which is assumed to be a predictive factor for preservation of visual acuity.

No MeSH data available.


Related in: MedlinePlus

SD-OCT of a patient from the control group—preangiogenic dry from of AMD.SD-OCT of the right eye of a patient from the control group with the dry form of AMD 2.5 years after the start of follow-up, showing persistent DPED. DPED symmetrically transitions into the detachment of the IS/OS photoreceptor junction, localized between the two arrows, where the beginning and end of junction detachment are indicated. In addition, the detached IS/OS photoreceptor junction shows uneven reflectivity and thickness of the retinal layer, a sign of incipient degenerative changes of the IS/OS junction, which are considered to be the result of the lack of junction nutrition due to its increased distance from the RPE [10, 11].
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fig1: SD-OCT of a patient from the control group—preangiogenic dry from of AMD.SD-OCT of the right eye of a patient from the control group with the dry form of AMD 2.5 years after the start of follow-up, showing persistent DPED. DPED symmetrically transitions into the detachment of the IS/OS photoreceptor junction, localized between the two arrows, where the beginning and end of junction detachment are indicated. In addition, the detached IS/OS photoreceptor junction shows uneven reflectivity and thickness of the retinal layer, a sign of incipient degenerative changes of the IS/OS junction, which are considered to be the result of the lack of junction nutrition due to its increased distance from the RPE [10, 11].

Mentions: Fundus photography and fluorescein angiography were performed using a digital fundus camera (Zeiss FF 450, Jena, Germany). The DPED area was measured in mm2 by fundus photography using VISUPAC software (Zeiss Meditec AG, Jena, Germany), which is acceptable for measuring the area of retinal affections [15]. Spectral domain- (SD-) OCT (Cirrus HD-OCT, Zeiss Meditec, Jena, Germany) with an axial resolution of 6 μm was used to evaluate central retinal thickness. Thickness in the central point of the 1 mm fixation zone was evaluated using 6 radial scans. SD-OCT enabled us to distinguish between DPED and the vascular type of retinal pigment epithelium detachment. A detailed image of the photoreceptor IS/OS junction was obtained using a 5-line raster scan, which precisely shows the shape, coherence, and defects of the photoreceptor IS/OS junction as well as the detachment of this layer from the retinal pigment epithelium (RPE). See Figure 1.


Preservation of the Photoreceptor Inner/Outer Segment Junction in Dry Age-Related Macular Degeneration Treated by Rheohemapheresis.

Rencová E, Bláha M, Studnička J, Bláha V, Lánská M, Renc O, Stepanov A, Kratochvílová V, Langrová H - J Ophthalmol (2015)

SD-OCT of a patient from the control group—preangiogenic dry from of AMD.SD-OCT of the right eye of a patient from the control group with the dry form of AMD 2.5 years after the start of follow-up, showing persistent DPED. DPED symmetrically transitions into the detachment of the IS/OS photoreceptor junction, localized between the two arrows, where the beginning and end of junction detachment are indicated. In addition, the detached IS/OS photoreceptor junction shows uneven reflectivity and thickness of the retinal layer, a sign of incipient degenerative changes of the IS/OS junction, which are considered to be the result of the lack of junction nutrition due to its increased distance from the RPE [10, 11].
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4553324&req=5

fig1: SD-OCT of a patient from the control group—preangiogenic dry from of AMD.SD-OCT of the right eye of a patient from the control group with the dry form of AMD 2.5 years after the start of follow-up, showing persistent DPED. DPED symmetrically transitions into the detachment of the IS/OS photoreceptor junction, localized between the two arrows, where the beginning and end of junction detachment are indicated. In addition, the detached IS/OS photoreceptor junction shows uneven reflectivity and thickness of the retinal layer, a sign of incipient degenerative changes of the IS/OS junction, which are considered to be the result of the lack of junction nutrition due to its increased distance from the RPE [10, 11].
Mentions: Fundus photography and fluorescein angiography were performed using a digital fundus camera (Zeiss FF 450, Jena, Germany). The DPED area was measured in mm2 by fundus photography using VISUPAC software (Zeiss Meditec AG, Jena, Germany), which is acceptable for measuring the area of retinal affections [15]. Spectral domain- (SD-) OCT (Cirrus HD-OCT, Zeiss Meditec, Jena, Germany) with an axial resolution of 6 μm was used to evaluate central retinal thickness. Thickness in the central point of the 1 mm fixation zone was evaluated using 6 radial scans. SD-OCT enabled us to distinguish between DPED and the vascular type of retinal pigment epithelium detachment. A detailed image of the photoreceptor IS/OS junction was obtained using a 5-line raster scan, which precisely shows the shape, coherence, and defects of the photoreceptor IS/OS junction as well as the detachment of this layer from the retinal pigment epithelium (RPE). See Figure 1.

Bottom Line: BCVA of treated patients increased insignificantly (P = 0.187) from median 74.0 letters (56.2 to 81.3 letters) to median 79.0 letters (57.3 to 83.4 letters), but it decreased significantly from 74.0 letters (25.2 to 82.6 letters) to 72.5 letters (23.4 to 83.1 letters) in the control group (P = 0.041).The mfERG responses in the region of eccentricity between 1.8° and 7° were significantly higher in treated patients (P = 0.04).Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Lékařská Fakulta, Fakultní Nemocnice, Sokolská 581, 500 09 Hradec Králové, Czech Republic.

ABSTRACT
Aim. To evaluate the long-term effect of rheohemapheresis (RHF) treatment of age-related macular degeneration (AMD) on photoreceptor IS/OS junction status. Methods. In our study, we followed 24 patients with dry AMD and drusenoid retinal pigment epithelium detachment (DPED) for a period of more than 2.5 years. Twelve patients (22 eyes) were treated by RHF and 12 controls (18 eyes) were randomized. The treated group underwent 8 RHF standardized procedures. We evaluated best-corrected visual acuity, IS/OS junction status (SD OCT), and macular function (multifocal electroretinography) at baseline and at 2.5-year follow-up. Results. RHF caused a decrease of whole-blood viscosity/plasma viscosity at about 15/12%. BCVA of treated patients increased insignificantly (P = 0.187) from median 74.0 letters (56.2 to 81.3 letters) to median 79.0 letters (57.3 to 83.4 letters), but it decreased significantly from 74.0 letters (25.2 to 82.6 letters) to 72.5 letters (23.4 to 83.1 letters) in the control group (P = 0.041). The mfERG responses in the region of eccentricity between 1.8° and 7° were significantly higher in treated patients (P = 0.04). Conclusions. RHF contributed to sparing of photoreceptor IS/OS junction integrity in the fovea, which is assumed to be a predictive factor for preservation of visual acuity.

No MeSH data available.


Related in: MedlinePlus