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The Treatment of Age-related Macular Degeneration (AMD) with Therapeutic Apheresis. A Follow-up of 4 Years
1Widder R. A., 1Farvili E., 1Reis R. G. J., 1Walter P., 2Kirchhof B., 1Borberg H., 1Brunner R.,
1Universität zu Köln, Zentrum für Augenheilkunde (Köln)
2Universität zu Köln, Zentrum für Augenheilkunde, Abteilung für Netzhaut- und Glaskörperchirurgie (Köln)
Purpose: Extracorporeal treatment procedures as a form of therapeutic apheresis are able to eliminate proteins and lipids from the blood and therefore able to optimize rheological parameters. The beneficial effect in ARMD was demonstrated over a treatment period of six month in a randomized trial (Brunner et al., Retina 2000), but there is a lack of information regarding the long-term effect of this treatment. This study reports the results of a four year treatment period in patients with the dry form of ARMD.
Method: 20 eyes of 20 patients with ARMD were treated with membrane differential filtration, selective adsorption (AR 2000, TR-350, Asahi Medical Tokyo) and plasma exchange. All patients were treated over a period of 3 years (mean: 6 treatments/year) and 12 of them over a period of 4 years. All patients suffered from the dry form of ARMD characterized by pigment clumping, soft and hard drusen and retinal degeneration. Clinical endpoint of the study was best corrected visual acuity (ETDRS-charts). Biochemical and rheological parameters were also measured.
Results: A total of 15/20 patients showed an improvement of visual acuity after two and three years while 7/12 patients showed an improvement of visual acuity after four years. After two years the mean improvement of visual acuity was 1.9 lines (20 eyes, p<0.05), 1.2 lines (20 eyes, p<0.05) after three years and 0.8 lines (12 eyes, p=0.77) after four years. A significant change of plasma- and whole blood viscosity as well as erythrocyte aggregation was shown.
Conclusions: This study demonstrates the positive influence of repetetive extracorporeal treatment procedures on the natural course of the dry form of ARMD. We were able to show an improvement of visual acuity over a period of three years and the intermediate results confirm the results of earlier studies. After four years a significant improvement of visual acuity was not shown neighter a significant deterioration which also could be interpreted as a success treating a disease with a devastating natural course.