Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Hofer, A.
The Ars ophthalmica Network - a Disease Management Program between the Kepler University Hospital and ophthalmologists for the treatment of exudative age-related macular degeneration
Humanmedizin; [ Diplomarbeit ] Medical University Graz; 2021. pp. 85
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Seidel Gerald
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- Abstract:
- Introduction: Age-related macular degeneration (AMD) is one of the leading causes of blindness in industrial nations. Intravitreal injections with VEGF-inhibitors have been approved since 2004 and are currently the first-line treatment. In Austria, therapy is provided almost exclusively in hospitals. One challenge in anti-VEGF therapy is that the effect usually decreases or has passed after a few weeks. Therefore, regular check-ups and, if the disease is active, re-treatments are indicated. Within the Ars ophthalmica Disease Management Program (DMP) at the Kepler University Clinic in Linz, check-ups do not take place at the hospital, but at practice-based ophthalmologist. As soon as macular lesions are detected, patients are referred directly to the eye clinic for therapy. In this way, the intramural area can be relieved, the patients are monitored close to home and, if necessary, can be treated without delay by direct referral to the injection. This thesis characterizes the population of the Ars ophthalmica DMP and describes the visual acuity and the central retinal thickness during the treatment. Methods: The data of this retrospective explorative analysis were collected in the period from January 2015 (start of the DMP) to December 2019 at the eye clinic of the Kepler University Hospital in Linz. 363 eyes from 269 patients were included in the analysis. For the analysis, intervals of 2, 6, 12, 24 and 36 months after inclusion in the study were defined. Demographic parameters, visual acuity, central retinal thickness in the OCT (optical coherence tomography) and injection frequency are used as parameters. Results: The mean age of the patients at the start of the study was 78.6 (± 8.3) years. A total of 43% of the study population were already treated with at least one intravitreal injection before the start of the study. Avastin was administered more frequently (65%) than Eylea (35%). Pretreated patients received Eylea more often (Eylea in 41% of all pretreated patients) than first-time treated patients (Eylea in 31%). The mean LogMAR visual acuity of the study population was 0.55 ± 0.37 at the start of the study. Two months after therapy started, there was a statistically significant increase in visual acuity (0.47 ± 0.36; p<0.001). The visual acuity of patients who finished their second therapy interval after 6 months was 0.48 ± 0.37 (p = 0.067). Analogous to this visual acuity after 12 months was 0.49 ± 0.35 (p = 0.309), after 24 months it was 0.50 ± 0.39 (p = 0.588) and after 36 months at 0.44 ± 0.33 (p = 0.599), always on the last day of the respective therapy cycle. Compared to the start of the study, there was an increase in visual acuity within the first 12 months, followed by a slight decrease in visual acuity after 24 and 36 months. At the start of the study, the mean central retinal thickness was 394 ± 123 µm. It decreased significantly after 2 months (315 ± 91 µm; p< 0.001), after 6 months it was 339 ± 125 µm (p< 0.001), after 12 months 325 ± 103 µm (p< 0.001), after two years 326 ± 103 µm (p< 0.001) and after three years 307 ± 64 µm (p< 0.001). The injection rate of those first treated who could potentially be treated over the respective period was 4.4 in the first year; 2.6 in the second year and 1.8 in the third year. Conclusion: Within the Ars ophthalmica DMP, an improvement of visual acuity was initially achieved. Long-term maintenance of visual acuity is difficult in clinical practice despite a low retinal thickness.