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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

(a) SD-OCT of the left eye of a patient with the dry form of AMD before initiation of rheohemapheresis treatment. A large photoreceptor IS/OS junction defect marked by arrows at its beginning and end. Only the top of the surface DPED under the central foveola shows remnants of previous photoreceptor IS/OS junction detachment (indicated by arrowheads) in the form of degraded degenerated material of the original junction. The photoreceptor IS/OS junction is normally attached to the RPE only peripherally from the arrows. Visual acuity at this stage was 20/80 (0.25). (b) Multifocal electroretinography. Superposition of mfERG responses to the fundus of the left eye of the patient from (a). (c) A three-dimensional image of the electrical activity of the retina. Left: A three-dimensional image of the electrical activity of the retina of the left eye of the patient from (a) and (b) compared to the normal-for-age image on the right (decrease of foveal and parafoveal responses below the normal range, i.e., grey-colored central depressions bordered by green, i.e., within normal range responses).
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fig2: (a) SD-OCT of the left eye of a patient with the dry form of AMD before initiation of rheohemapheresis treatment. A large photoreceptor IS/OS junction defect marked by arrows at its beginning and end. Only the top of the surface DPED under the central foveola shows remnants of previous photoreceptor IS/OS junction detachment (indicated by arrowheads) in the form of degraded degenerated material of the original junction. The photoreceptor IS/OS junction is normally attached to the RPE only peripherally from the arrows. Visual acuity at this stage was 20/80 (0.25). (b) Multifocal electroretinography. Superposition of mfERG responses to the fundus of the left eye of the patient from (a). (c) A three-dimensional image of the electrical activity of the retina. Left: A three-dimensional image of the electrical activity of the retina of the left eye of the patient from (a) and (b) compared to the normal-for-age image on the right (decrease of foveal and parafoveal responses below the normal range, i.e., grey-colored central depressions bordered by green, i.e., within normal range responses).

Mentions: In general, retinal activity remained stable or even improved in treated patients with early decrease or complete disappearance of DPED and detachment of the photoreceptor IS/OS junction, along with preservation of its integrity or development of only small defects in the parafoveal region (Figures 2(a), 2(b), 2(c), 3(b), and 3(c)). In contrast, in patients with long-lasting or persistent DPED with detachment of the IS/OS junction and development of its defects or even development of CNV, retinal activity was even reduced.


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)

(a) SD-OCT of the left eye of a patient with the dry form of AMD before initiation of rheohemapheresis treatment. A large photoreceptor IS/OS junction defect marked by arrows at its beginning and end. Only the top of the surface DPED under the central foveola shows remnants of previous photoreceptor IS/OS junction detachment (indicated by arrowheads) in the form of degraded degenerated material of the original junction. The photoreceptor IS/OS junction is normally attached to the RPE only peripherally from the arrows. Visual acuity at this stage was 20/80 (0.25). (b) Multifocal electroretinography. Superposition of mfERG responses to the fundus of the left eye of the patient from (a). (c) A three-dimensional image of the electrical activity of the retina. Left: A three-dimensional image of the electrical activity of the retina of the left eye of the patient from (a) and (b) compared to the normal-for-age image on the right (decrease of foveal and parafoveal responses below the normal range, i.e., grey-colored central depressions bordered by green, i.e., within normal range responses).
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4553324&req=5

fig2: (a) SD-OCT of the left eye of a patient with the dry form of AMD before initiation of rheohemapheresis treatment. A large photoreceptor IS/OS junction defect marked by arrows at its beginning and end. Only the top of the surface DPED under the central foveola shows remnants of previous photoreceptor IS/OS junction detachment (indicated by arrowheads) in the form of degraded degenerated material of the original junction. The photoreceptor IS/OS junction is normally attached to the RPE only peripherally from the arrows. Visual acuity at this stage was 20/80 (0.25). (b) Multifocal electroretinography. Superposition of mfERG responses to the fundus of the left eye of the patient from (a). (c) A three-dimensional image of the electrical activity of the retina. Left: A three-dimensional image of the electrical activity of the retina of the left eye of the patient from (a) and (b) compared to the normal-for-age image on the right (decrease of foveal and parafoveal responses below the normal range, i.e., grey-colored central depressions bordered by green, i.e., within normal range responses).
Mentions: In general, retinal activity remained stable or even improved in treated patients with early decrease or complete disappearance of DPED and detachment of the photoreceptor IS/OS junction, along with preservation of its integrity or development of only small defects in the parafoveal region (Figures 2(a), 2(b), 2(c), 3(b), and 3(c)). In contrast, in patients with long-lasting or persistent DPED with detachment of the IS/OS junction and development of its defects or even development of CNV, retinal activity was even reduced.

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