Factors affecting success in advanced wet type age-related macula degeneration treatment

In this study; We aimed to investigate the factors affecting success in the treatment of advanced wet type age-related macular degeneration in the Karadeniz Technical University Ophthalmolgy Department Retina unit. Patients who were diagnosed as age-type ARMD between January 2013 and December 2019 and who received at least 3 consecutive intravitreal anti-VEGF injections due to macular edema, intraretinal hemorrhage and choroidal neovascularization were included in the study. This study is a retrospective study. Demographic features, pre-treatment (baseline) and final BCVA (best corrected visual acuity), and visual acuity levels before and after treatment were determined for all patients included in the study. Retinal photographs were taken in all patients, and spectral domain OCT (RTVue, Optovue, Inc., Fremont, CA) and FFA (Optos, California, Optos PLC, Dunfermline, UK) were evaluated. In OCT images, intra-retinal and subretinal fluid accumulation, CRT (central retinal thickness) and detectable CNV thickness were mesured. Presence of PED was noted in the patients. The size of the CNV causing fluorescein leakage was evaluated by angiography. At least 3 loading doses of IVR (intravitreal) anti-VEGF injection were planned for the patients. Ninety five eyes of 59 patients were included in the study. 39 (66.1%) of the patients were male and 20 were female (33.9%), and the mean age was 70 ± 5.62 (64-81). While serous PED was observed in 82 (86.3%) of the examined eyes, PED was not observed in 13 (13.7%). Sixty-five (68.4%) of the eyes had CNV detectable by OCT and 33 (34.7%) were Type-1 CNV, while 32 (33.7) were Type-2 CNV. Visual acuity were found to be 0.91 ± 0.72 logMAR before treatment and 1.22 ± 0.81 logMAR after treatment. While the FFA leakage area before treatment was on average 14.18 ± 17.81 mm2, it decreased to 11.87 ± 14.79 mm2 after treatment. CRT measured with OCT was initially 324.8 ± 197.74 micron while it was 250.15 ± 108.86 micron after treatment. Despite treatment, the visual acuities decreased over time, the CRT values and the leakage area detected in FFA decreased. Which situation was found statistically significant. Eyes with increased CRT and eyes with decresed CRT were compared in terms of CNV type and drug replacement need. As a result, it was concluded that the success of anti VEGF treatment in advanced stage wet type ARMD treatment is affected by many factors, but the most important factor is the state of the visual acuity. The prognosis was poor in patients with low vision at the beginning of treatment (despite morphological improvement).