Ibrahim Kocak
Medipol University, Turkey
Title: A challenging aspect of AMD: Clinical features and treatment of pigment epithelium detachment
Biography
Biography: Ibrahim Kocak
Abstract
Background: Treatment of pigment epithelial (RPE) detachment (PED) is a controversial issue and there are no recommended guidelines for their management. The treatment options have been laser grid or scattered photocoagulation, photodynamic therapy (PDT), anti-vascular endothelial growth factor (VEGF) therapy with ranibizumab or bevacizumab, nevertheless most of them are reported to be ineffective or with high complication rates.
Method: Large landmark clinical trials like ANCHOR and MARINA did not report the PED response to ranibizumab treatment. A smaller study, pronto, highlighted the resistance of PEDs to ranibizumab therapy compared to sub-retinal fluid and intra-retinal fluid. Similar results were reported for bevacizumab therapy in terms of sub-RPE fluid resistance. However, some promising reports show efficacy of aflibercept in those resistant cases. In our institution’s experience, we have promising results with aflibercept in PED cases.
Results: Aflibercept treatment may have a reasonable rationale by virtue of recalcitrant feature of PED. In previous studies, Major, He, Kanesa, Broadhead all reported reduction in PED dimensions and some of them reported visual acuity improvement. In our institution’s experience, we observed significant decrease in PED dimensions and visual acuity improvement after transitioning aflibercept.
Conclusion & Significance: Aflibercept seems to have promising functional and anatomical outcomes in treatment resistant PED cases. Further investigations are needed to provide a recommended treatment guideline and to define more treatment sensitive subtypes of PED.