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Η φυσική πορεία της ασυμπτωματικής ξηράς μορφής ηλικιακής εκφύλισης της ωχράς με πρώιμα σημάδια εξιδρωματικής μετατροπής (Master thesis)

Βοϊτσίδης, Χρήστος

The purpose of this postgraduate thesis is to assess and observe the natural course of asymptomatic Age Macular Degeneration(AMD), which presents with early exudative signs on the Optical Coherence Tomography (OCT). Furthermore, it aims to identify and assess the associated risk factors (early signs of exudation) and causes of deterioration of patients' vision, resulting in their need for anti-vascular endothelial growth factor (anti- VEGF) therapy. It is a single centered, retrospective, observational, cohort study. All patients who participated were aged 50 and above and were enrolled in the study while still asymptomatic with their vision not showing any signs of aggravation. In the context of the study, we observed the time the early signs of exudation were documented for the first time. None of the patients had experienced retinal bleeding in the macula after fundus examination at entry into the study. All patients in the sample had their visual acuity measured, received colour photography, angiography and macular imaging with OCT spectral domain at baseline. Patients were systematically reviewed, after their enrollment in the study, in regular time intervals. In cases where visual acuity was reduced, intra and/or subretinal fluid was observed, pigment epithelium detachment was present, or in eyes with retinal bleeding and active leakage seen on the FFA, intra-vitreal injections were used with anti-vascular endothelial growth factors (anti-VEGF) and the patient follow-up appointments were adjusted accordingly. All patients in the sample completed a follow-up period of at least 6 months. Thirteen patients (13 eyes) fulfilled the inclusion criteria of the study and were able to complete the follow up program. The median best corrected visual acuity (BCVA) was 0,2 (0,00 - 1,00) and 0,2 (0,00 - 0,7) at baseline and at the end of the follow up period. No statistical difference was observed (Wilcoxon test, p =1.0). Eight out of the 13 patients required treatment with anti-VGF factors, which also demonstrates that the conversion rate of the disease from dry to wet in our sample was 62%. Mean time to conversion was 35,4 months with standard deviation SD +-26,6 months. According to the statistical analysis based on Logrank test, the parameter P for all 4 patient groups based on the risk factors ( intra-retinal fluid-IRF, sub-retinal fluid- SRF, pigment epithelial detachment-PED, pigment epithelial detachment combined with intra or subretinal fluid- PED + fluid) was found to be equal to 0,65, which has no statistical significance and lead us to the conclusion that the presence of these 4 factors mentioned above have the same probability and weighting on the risk of the disease conversion from dry to wet form. In conclusion, this study favors the view that asymptomatic neovascular AMD does not need to be treated immediately with anti-VEGF agents in the absence of biological markers or in the absence of visual impairment in patients' eyesight. Nevertheless, these patients should be monitored frequently to avoid the occurrence of a disease that could lead to an irreversible loss of vision.