K 769Rheopheresis a systemic therapeutic approach for dry age-related macular degeneration (AMD) with large drusen
A. Fell, W. Wahls, C. Fassbender, R. Klingel
Purpose: The prognosis of eyes with dry AMD and large lipid rich drusen in combination with late AMD in the fellow eye is very poor. Protein and lipid deposits in Bruch´s membrane and choroidea disturb the metabolism of the retinal pigment epithelium (RPE). The impaired microcirculation is related to the progressive loss of RPE function. Elimination of high molecular rheologically relevant plasma proteins (LDL-cholesterol, fibrinogen,
a -2-macroglobulin) by Rheopheresis leads to an improvement of microcirculation. Recently two controlled clinical trials demonstrated safety and efficacy of Rheopheresis for the treatment of AMD including the AMD subgroup with large soft drusen (Widder et al., IOVS 40: S377, 1999; Swartz et al., IOVS 40: S319, 1999). Aim of this investigation was to evaluate the efficacy of Rheopheresis for the treatment of early high risk AMD.
Patients and methods: 10 Patients with early AMD in one eye (soft drusen, pigment epithelial detachment), initial visual acuity 0.25 0.8, received 10 Rheopheresis treatments within 17 weeks. The fellow eye was characterized by late AMD with CNV or geographic atrophy. In week 18 and 30 ETDRS visual acuity, color vision, contrast sensitivity and health related quality of life was determined.
Results: The therapeutic effect of 100 treatments was analyzed. Early AMD: 6/10 eyes showed an improvement of visual acuity from 1-3 ETDRS lines, 3 eyes remained stable, 1 eye decreased 2 lines. Late AMD: 5/10 eyes improved ³ 1 line, 4 eyes remained stable, 1 eye decreased > 1 line.
Conclusions: A defined subgroup of dry AMD with high risk of loss in visual acuity may benefit from Rheopheresis. The fellow eye with late AMD may profit simultaneously due to the systemic therapeutic approach. Further investigations will help to define the guidelines for the indication of Rheopheresis for AMD more precisely.
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