Haemorheopheresis could block the progression of the dry form of age-related macular degeneration with soft drusen to the neovascular form.
OBJECTIVE
To evaluate the influence of haemorheopheresis on anatomical and functional findings in patients with soft-drusen maculopathy.


METHODS
We investigated 29 eyes (16 patients) and randomized 25 eyes (16 controls) with soft-drusen maculopathy [soft, confluent and reticular drusen, drusenoid retinal pigment epithelium detachment (RPED)]. Each patient received a series of eight haemorheophereses (cascade filtration of 1.5 plasma volume) within 10 weeks. The patients were followed up using Early Treatment Diabetic Retinopathy Study (ETDRS) charts, optical coherence tomography, fluorescein angiography, electroretinography and measurements of pulsed ocular blood flow.


RESULTS
After the procedures, there was a substantial reduction in rheologically active substances [lipoproteins, α2-macroglobulin, immunoglobulin M (IgM), fibrinogen], plasma and blood viscosity. At the 1.5-year follow-up, we noticed soft drusen absorption; reattachment of drusenoid RPED and stabilization or improvement of visual acuity occurred in 72% of patients in comparison to only 39% of patients in the control group. Full-field electroretinograms showed significantly higher scotopic activity of treated patients in comparison with the control group, and mainly insignificant differences in photopic activity between both groups. Despite the significant increase of activity in the paramacular retina in treated patients, the differences in amplitudes of multifocal electroretinography (mfERG) average responses were insignificant between groups.


CONCLUSIONS
Haemorheopheresis seems to be capable of changing the activity of promoters of the natural course of soft-drusen maculopathy, its development and progression. Visual acuity and electrical activity of the retina can be stabilized or even improved. The therapy has been shown to be effective and safe.
Rencová
Eva
E
Department of Ophthalmology, Charles University, Hradec Králové, Czech Republic.
Bláha
Milan
M
Studnička
Jan
J
Blažek
Martin
M
Bláha
Vladimír
V
Dusová
Jaroslava
J
Malý
Jaroslav
J
Kyprianou
Georgia
G
Vašátko
Tomáš
T
Langrová
Hana
H
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D020256:Choroidal Neovascularization / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D004596:Electroretinography; D005260:Female; D005500:Follow-Up Studies; D057092:Geographic Atrophy / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008268:Macular Degeneration / Q000473:pathology / Q000628:therapy; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D010781:Photography; D010956:Plasmapheresis / Q000379:methods*; D012163:Retinal Detachment / Q000473:pathology / Q000628:therapy; D015593:Retinal Drusen / Q000473:pathology / Q000628:therapy*; D012212:Rheology / Q000379:methods; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity
D015415:Biomarkers