An Experimental and Clinical Justification for Prolongation of Action of Anti-VEGF Drug in the “Wet” Form Age-related Macular Degeneration by the Introduction in the Back Subtenon Space on the Basis of Viscous Media

Purpose. Experimental-clinical substantiation of the effectiveness of subtenon injection of anti-VEGF drug on the viscous media with the purpose of strengthening and prolong of therapeutic effect in the treatment of wet form of age-related macular degeneration (AMD).

Material and methods. The experimental part of the work was carried out on 10 rabbits (20 eyes). The main group of rabbits (10 eyes) were injected into the back subtenon space 0,5 ml of a 10% solution of fluorescein on the viscous mediа, which was used as a 2% solution of hydroxypropylmethylcellulose; a control (10 eyes) — without the viscous medium. After enucleation and isolation of ocular tissues in the posterior pole was performed water extraction of the dye determined the intensity of fluorescence after 3, 7, 10, 14 and 16 days after injection. In the clinical part of the work included 32 patients (34 eyes) with the wet form of AMD, to be administered anti-VEGF drug at a dose of 12,5 mg (0,5 ml) into the back subtenon space аt the same viscous media. The efficacy and safety were evaluated for 6 months.

Results. As a result of the experimental study found that the length of stay in the back subtenon space of fluorescein solution of rabbit’s eye, introduced in the viscous medium to 2 times longer than without it. In a clinical study of stabilization was observed in 52,9 % of cases, improved visual function in 35,3 % of cases. Deterioration in visual functions noted in 11,8 % of cases. It was also noted improvement in photo-stress test. According OCT showed a decrease in central retinal thickness 2 times by reducing the size and volume of lesions by 30%, a significant decrease transsudativ processes in the retina in all patients, indicating that suppression of choroidal neovascularization.

Conclusion: Subtenon injections of anti-VEGF drug is safe and has a positive effect in wet AMD, and its application to a viscous media has a prolonged action or property interest in any material or method mentioned. 

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