Uticaj intravitrealne terapije inhibitorima angiogeneze na funkcionalni i morfološki nalaz kod vlažne forme senilne degeneracije makule

Abstract

Uvod: Senilna degeneracija makule (SDM) je vodeći uzrok ozbiljnog, trajnog oštećenja vida kod ljudi preko pedeset godina života. To je stanje kod koga primarno dolazi do oštećenja fotoreceptora makule. Subretinalna ili horoidalna neovaskularizacija je patološki supstrat za formiranje neovaskularne membrane (SNM) kod vlažne forme senilne degeneracije makule (nSDM). U patogenezi ove membrane značajnu ulogu, ako ne i ključnu, ima angiogenetski faktor, tzv. vaskularni endotelni faktor rasta (VEGF), koji je odgovoran za povećanje vaskularnog permeabiliteta i stimulaciju neovaskularizacije. Zato je jedna od mogućih strategija prevencije i tretmana subretinalne neovaskularne membrane inhibicija VEGF i smanjenje vaskularnog permeabiliteta. Cilj: je da se utvrditi efikasnost i bezbednost intravitrealne primene leka iz grupe ihhibitora VEGF, bevacizumaba u dozi od 1,25 mg (0,1mL) u terapiji nSDM, kao i da li intravitrealna primena ovog leka po PRN protokolu (pro-re-nata, ili po potrebi), utiče na promenu vidne oštrine (poboljšanje/stabilizacija/pogoršanje) i veličinu SNM merene optičkom koherentnom tomografijom (OCT) u periodu praćenja od 44±4 nedelje. Cilj ovog istraživanja je i da se utvrdi eventualni prognostički značaj vidne oštrine i vrste SNM ustanovljene fluoresceinskom angiografijom (FA) i OCT-om na krajnji ishod terapije. Takođe, jedan od ciljeva je i da se utvrde mogući lokalni i sistemsi neželjeni efekti intravitrealno aplikovanog bevacizumaba i njegov potencijalni efekat na promenu u vrednostima sistolnog i dijastolnog arterijskog krvnog pritiska, s obzirom da se lek primenjuje "off label". Metodologija: U retrospektivnu kliničku komparativnu studiju uključeno je 92 pacijenta sa dijagnozom nSDM. Dijagnoza nSDM je ustanovljena kliničkim pregledom, a potvrđena FA i OCT-om. Kriterijum uključenja bio je postojanje SNM tačno definisanog tipa (klasična, minimalno klasična ili okultna)...

Introduction: Age-related macular degeneration (AMD) is the leading cause of serious, permanent sight damage after the age of fifty. In this condition macular photoreceptors are the primary sight of damage. Subretinal or choroidal neovascularization is the pathological substrate underlying the formation of a subretinal, choroidal neovascular membrane (CNM) in the wet form of age-related macular degeneration (wet AMD). In the pathogenesis of this membrane an important, if not crucial role is played by an angiogenesis factor known as vascular endothelial growth factor (VEGF), which is responsible for increasing the vascular permeability and stimulating neovascularization. Therefore, one of the possible strategies in the prevention and treatment of subretinal neovascular membrane is inhibition of VEGF and decrease in vascular permeability. Aim: is to determine the efficacy and safety of intravitreal administration of 1.25mg (0.1mL) of the vascular endothelial growth factor inhibitor bevacizumab in the treatment of wet AMD, as well as to determine whether PRN (pro-re-nata, or as needed) application of this drug has any influence on visual acuity (improvement/stabilization/deterioration) and the size of SNM measured by optical coherence tomography (OCT), in the follow-up period of 44±4 weeks. The aim of this research is also to determine the prognostic importance of visual acuity and CNM type determined by fluorescein angiography (FAG) and OCT on the outcome of treatment. Moreover, one of the aims is to determine the possible local or systemic side effects of the intravitreal application of bevacizumab and its potential effects on systolic and diastolic blood pressure, considering the “off label” application of the drug. Methodology: A total of 92 patients with the diagnosis of wet AMD were included in the retrospective clinical comparative study. The diagnosis of wet AMD was established by physical exam, and confirmed on FAG and OCT. The inclusion criterion was the existence of a particular type of SNM (classic, minimally classic or occult)...