Evaluation of clinical factors affecting the response of pigment epithelial detachment to anti-VEGF loading dose in cases of recurrent age-related macular degeneration with pigment epithelial detachment

Objective: To investigate the effect of demographic and clinical factors on the proportional change in PED height after loading dose in recurrent age-related macular degeneration (AMD) patients with pigment epithelial detachment (PED). Materials and Methods: The data of AMD patients who were followed and treated in the retina unit of our clinic were retrospectively analysed. 151 eyes of 151 patients with recurrent AMD with PED who received anti-VEGF loading dose and met the inclusion criteria were divided into 3 groups as responders, partial responders and non-responders according to the proportional response of PED height after loading dose. Age, gender, lens status, anti-VEGF agent used, intraocular pressure (IOP), best corrected visual acuity (BCVA), autorefractometer measurements, body mass index (BMI), mean arterial pressure (MAP), central corneal thickness (CCT), axial length (AL) measurements, hemogram and biochemistry values including neutrophil/lymphocyte, FBS (fasting blood glucose), HbA1c, serum lipids, sedimentation and CRP values were recorded. Recurrence dates, number of recurrences, number of loading dose injections and the date of completion of the loading dose were determined and recorded. Choroidal thickness (fcEDI, fnEDI, ftEDI), central retinal thickness (CRT), retinal nerve fibre layer thickness (RNFL), presence of intraretinal fluid (IRF), presence of subretinal fluid (SRF) were determined by spectral domain optical coherence tomography (SD-OCT), The localisation, height, width of the PED closest to the choroidal neovascularisation (CNV), and the classification of the PED as solid, hollow or mixed PED based on the SD-OCT image were recorded. Results: Of the patients, 19.2 % were non-responders, 49.6 % were partial responders and 31.2 % were responders. Clinical data were compared between these 3 groups and statistically significant differences were found in CRT, spherical equivalent (sEq), PED width after loading dose and anti-VEGF agent parameters (p values 0.042, 0.019, 0.025 and 0.009, respectively). There was a statistically significant positive weak correlation between the proportional response of PED to loading dose and spherical equivalent, MAP, CRT, fcEDI (r=0.239 p<0.01, r=0.268 p<0.01, r=0.239 p<0.01 and r=0.166 p<0.01, respectively). The effect of MAP, sEq, CRT, fcEDI values and these four parameters together on the proportional change of PED height after loading dose was evaluated by linear regression analysis (r2 values 0,072, 0,057, 0,057, 0,028 and 0,080, respectively). Nagelkerke's r2 values for MAP, sEq, CRT and fcEDI indicate that the effect of these parameters in predicting the proportional change in PED height after loading dose is low. Conclusion: The results obtained in this study showed that the proportional response of PED to loading dose in patients with recurrent AMD was affected by the clinical and demographic parameters of the patients and it was determined that a proportional decrease in the height of PED occurred after anti-VEGF loading dose. Although it was determined that the level of this proportional response was related with sEq, CRT, PED width after loading dose and anti-VEGF agent used, it was determined that these parameters could not explain the entire change. Keywords: Age-related macular degeneration, Choroidal neovascularisation, Pigment epithelial detachment, Optical coherence tomography, Treat and extend.