The influence of multilayered retinal pigment epithelium detachment on visual acuity in age-related macular degeneration

Relevance Multilayered retinal pigment epithelial detachment (MRE) is divided into several layers: fibrocellular, fibrovascular, and prechoroidal cleft [1]. Despite the sufficient effectiveness of antiangiogenic therapy, according to the literature, the effect of the layers underlying MRE on visual acuity is inconsistent [2, 3]. Objective Analysis of the effect of multilayered retinal pigment epithelial detachment on functional parameters in the exudative form of age-related macular degeneration. Material and methods This study included 50 patients (50 eyes) with multilayered MRE who had previously received multiple intravitreal injections of anti-VEGF drugs. The average age of the patients was 70.4 ± 8.9 years. All patients underwent standard ophthalmological examination methods. Special examination methods included: optical coherence tomography (OCT) and OCT angiography on the Spectralis HRA+OCT device "Heidelberg Engineering" (Germany) in the standard mode. In this study, all patients received loading intravitreal injections of the drug faricimab (Vabismo®, F. Hoffmann-La Roche Ltd, Switzerland) in a volume of 0.05 ml (6 mg). The data were assessed before and after loading injections. Statistical processing of materials was carried out using the standard IBM SPSS Statistics program. Results Before the study, an indirect correlation was found between the prechoroidal cleft and visual acuity (p = 0.039). No effect of changes in the fibrocellular and fibrovascular layers before treatment and after loading injections of the anti-VEGF drug on vision was found. These data may indicate one of the theories of the occurrence of prechoroidal cleft, which suggests that its formation occurs due to the activity of newly formed vessels and fluid exudation, and not only mechanical traction of the neovascular complex from Bruch's membrane. Conclusion Despite the improvement of morphometric parameters and visual acuity, when assessing the results of the effectiveness of antiangiogenic therapy, attention should be paid not only to the exudative fluid, but also to changes in the prechoroidal cleft. Key words: multilayered retinal pigment epithelium detachment; anti-VEGF therapy