Morphological characteristics of eyes with neovascular age-related macular degeneration and good long-term visual outcomes after anti-VEGF therapy

Abstract

PurposeTo analyse the morphological characteristics of eyes with neovascular age-related macular degeneration (AMD) with good long-term visual acuity after anti-VEGF (vascular endothelial growth factor) therapy.MethodsRetrospective, observational study of 175 patients with neovascular AMD with >5 years of follow-up after initiating anti-VEGF therapy. Spectral-domain optical coherence tomography images were assessed for thickness of pigment epithelial detachment (PED), subretinal hyper-reflective material (SHRM), subretinal fluid and subfoveal choroidal, as well as the integrity of the outer retinal bands.ResultsThe final analysis cohort included 203 eyes (175 patients) followed for a mean of 7.84±1.70 years (range: 5–11). The maximum PED thickness in the foveal central subfield (FCS) was significantly lower (p<0.001) in the poor vision group (13.11 μm) compared with the intermediate (86.25 μm) or good (97.92 μm) vision groups, respectively. In contrast, the maximum thickness of SHRM in the FCS was significantly thicker (p<0.001) in eyes with poor vision (149.46 μm) compared with eyes with intermediate vision (64.37 μm) which in turn were significantly thicker (p<0.001) than eyes with good vision (9.35 μm). The good vision group also had better continuity of all outer retinal bands (external limiting membrane, ellipsoid zone, and retinal pigment epithelium) compared with the other two groups (all p<0.001).ConclusionA thicker PED and thinner SHRM were correlated with better vision in eyes with neovascular AMD following long-term anti-VEGF therapy. If replicated in future prospective studies, these findings may have implications for design of optimal anatomic endpoints for neovascular AMD treatment.

Capturing the Transition From Intermediate to Neovascular AMD: Longitudinal Inner Retinal Thinning and Factors Associated With Neuronal Loss

“…Several studies that have adopted structural OCT have observed that eyes with resolved exudation secondary to neovascular AMD may feature an attenuation of the outer retinal layers. 22 , 23 Assuming that AMD is considered to be primarily an outer retina disease and given that inner neuronal loss cannot induce a secondary impairment of the photoreceptors, our results would appear to support the postreceptoral hypothesis regarding the inner retinal thinning observed after the transition from intermediate to exudative neovascular AMD.…”

“…Successively, the same readers independently graded eligible eyes for qualitative OCT features that may represent signs of MNV exudation, including the presence of intraretinal fluid (IRF), subretinal fluid (SRF), and subretinal hyperreflective material (SHRM), as previously described. 22 This grading was performed at the following visits: (1) follow-up visit with first evidence of treatment-naïve exudative MNV, and (2) 1-month follow-up visit after completion of the loading dose of anti-VEGF therapy. As stated above, the presence of OCT signs of exudation at the 12-month follow-up visit was an exclusion criterion in our analysis; therefore, this assessment was previously performed for eligibility.…”

“…These bands were graded as being absent, discontinuous, or intact, as has been done previously. 22 , 23 Alterations of the RPE within the fovea —OCT images were also reviewed for the integrity of the RPE. The RPE was also graded as being absent, discontinuous, or intact.…”

“…These bands were graded as being absent, discontinuous, or intact, as has been done previously. 22 , 23 …”

A real-world study assessing the impact of retinal fluid on visual acuity outcomes in patients with neovascular age-related macular degeneration in Korea

“…In general, the presence of sub-RPE fluid is not considered to be closely associated with visual prognosis 40 . But few studies have suggested that the sub-RPE fluid can be associated with the prognosis in some circumstances 41 , 42 . In addition, the incidence of sub-RPE fluid has not been studied in a large Korean cohort.…”