Alteração no volume de drusas como critério de progressão da degeneração macular relacionada à idade

• Ano de defesa: 2017
• Autor(a) principal: Garcia Filho, Carlos Alexandre de Amorim [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Optical coherence tomography; Age-related macular degeneration; Drusas; Eculizumab; System complement; Tomografia de coerência óptica; Degeneração macular relacionada à idade; Eculizumabe; Sistema complemento
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5279069; http://repositorio.unifesp.br/handle/11600/50583

PURPOSE: To verify the utility of an algorithm that measures the area and volume of drusen with spectral domain optical coherence tomography (SD OCT) to study the natural history of drusen and drusenoid retinal pigment epithelial detachment (drusenoid PED). To compare the SD OCT automatic measurements with color fundus image manual measurements, and to validate these measurements as a clinical tool for following patients with age related macular degeneration (AMD). METHODS: Three studies were developed. A prospective, natural history study included patients with drusenoid PED in the absence of neovascularization or geographic atrophy (GA). Area and volume were measured with SD OCT and patients were followed for at least 6 months. In the second study, the area of drusen were measured automatically with SD OCT and manually with color fundus image. Measurements were compared at baseline, 3 months and 6 months of follow up. The third study was a prospective, randomized, double masked, controlled with placebo clinical trial to evaluated the efficacy of complement inhibition in intermediate AMD patients. RESULTS: The natural history of drusenoid PED was identified using SD OCT. Half of the patients remained stable during follow up, 31.25% developed GA, 12.5% developed neovascularization and in 6.25% of patients the drusenoid PED regressed without development of late phases of AMD. In the second article, the area measured with color fundus image was systematically higher than the area measured with SD OCT. However, the change overtime in drusen area was similar with both imaging modalities. In the third study, SD OCT was able to measure the drusen volume change overtime, however, the changes were similar in both study and placebo groups. CONCLUSIONS: The new SD OCT algorithm capable of measuring the area and volume of drusen was able to follow the natural history of drusenoid PED. The drusen area change overtime was similar when measured automatically with SD OCT and manually with color fundus image. Data from these studies shows that measurement of drusen area and volume with SD OCT may be useful when designing future clinical trials invlving patients with intermediate AMD. Multiple endpoint trial may be designed to test the efficacy of a treatment in intermediate AMD, defined as the ability to prevent drusen growth and the development of neovascularization or GA.