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Master Thesis

Dégénérescence maculaire liée à l'âge et traitement par injections d'anti-VEGF : suivi sur 18 mois

Abstract : PURPOSE: to objectively evaluate the evolution of visual acuity in the case of wet Age-Related Macular Degeneration (AMD) only treated by intravitreal injections of anti-VEGF agents for 18 months from the day of the diagnosis. METHODS: 41 patients with wet AMD monitored in the ophthalmology unit of Gabriel-Montpied Hospital during a period equal or superior to 18 months and who underwent an angiography and an Optical Coherence Tomography (OCT) at the time of their baseline examination, were included in the study. We mainly studied the evolution of visual acuity (main measure) through four significant measures: at the baseline (AV1), after the induction phase of three intravitreal injections (AV2), the best visual acuity measured along the 18 months (AV3) and the last measurement of visual acuity at 18 months. At the same time, we listed several signs of wet AMD (increased retinal thickness, retinal detachment, pigmentary epithelium detachment) encountered at the baseline and later found during exams despite the treatment; and specified the presence of metamorphopsia, intravitreal bleeding and contralateral damage. The use of another treatment in the past and/or at the time of our period of study (photodynamic therapy) was used to exclude individuals from participation in our clinical trial. RESULTS: in our study, the strategy used for all patients is called “Pro Re Nata” (PRN); Lucentis® and Eylea® are the two main injection products with an average time of 5 months between two injections. By comparing AV1 and AV4, we can observe an increase of visual acuity, corresponding to a gain of more than 2 lines of visual acuity on the Monoyer chart (34.15%) and mostly, a maintenance of vision (56.1%). Assuming that the treatment is efficient when the vision is improved or stabilized, the success rate is 85%. By comparing AV1 and AV3, the average gain of visual acuity is around 2 lines for distance vision and patients can overall read from Jager 5 to Jager 2 for near vision. However, we notice a clear persistence of the clinical signs of wet AMD found at the baseline examination and relapses are common despite the treatment.In addition, the monitoring is very strict for both patients and ophthalmologists. CONCLUSION: the high success rate found at the end of our study (85%) shows the absolute efficiency of anti-VEGF factors for a period of 18 months. The others clinical trials on the subject are unanimous: intravitreal injections of anti-VEGF agents remain the reference treatment for wet AMD. But it is still impossible to completely avoid relapses by interrupting neovascular activity at this day; and the benefits of the treatment seem to have a fixed period of time. A more flexible and personal treatment strategy, such as Know & Treat would reduce the high number of ophthalmologic controls (once per month with PRN) without affecting the treatment’s efficiency.
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Master Thesis
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Sarah Trenti. Dégénérescence maculaire liée à l'âge et traitement par injections d'anti-VEGF : suivi sur 18 mois. Médecine humaine et pathologie. 2017. ⟨dumas-01697482⟩



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