Correlation between visual acuity, external limiting membrane and photoreceptor status in patients with neovascular age-related macular degeneration treated with bevacizumab
Abstract
Background/Aim. The integrity of outer retinal structures, primarily the photoreceptor layer, is important because of its direct correlation with visual acuity. The aim of this study was to investigate the correlation between best-corrected visual acuity (BCVA), the foveal photoreceptor-inner segment/outer segment (IS/OS) junction and external limiting membrane (ELM) in patients with neovascular age-related macular degeneration (NVAMD) after the treatment with bevacizumab, as well as the correlation between the above-mentioned parameters and different types of neovascular membrane, classified by fluorescein angiography (FA). Methods. The study included 82 patients with NVAMD, treated with intravitreal bevacizumab. All patients underwent a basic ophthalmological examination, FA and optical coherence tomography (OCT). Based on the results of FA, all the patients were divided into two main groups – type I (the occult and minimally classic) and type II (classic and predominantly classic) of the choroidal neovascular membrane (CNV). The OCT images revealed either the presence or the absence of IS/OS and ELM. Results. After the treatment, the mean best corrected visual acuity improved significantly in both groups (p < 0.01). Preserved IS/OS and ELM were registered in a smaller number of patients as compared to the condition before the treatment (p < 0.01). After the treatment, the mean BCVA was significantly better in patients with preserved IS/OS and ELM (p < 0.01). In addition, we registered a higher number of patients with preserved ELM in the first group than in the second group (p < 0.01), whereas there was no significant difference in the integrity of IS/OS between the groups (p > 0.05). Conclusion. The patients with preserved IS/OS and ELM achieved better final visual acuity as compared to the patients without preserved IS/OS and ELM. In our patients, the absence of IS/OS and ELM were more frequent in type II (classic and predominantly classic) CNV than in type I (the occult and minimally classic) CNV.
References
Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T. ANCHOR Study Group. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: Two-year results of the ANCHOR study. Ophthalmology 2009; 116(1): e57−65.
Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY. MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Eng J Med 2006; 355(14): 1419−31.
Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, Grunwald JE, et al. Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 2012; 119(7): 1388−98.
American Academy of Ophthalmology. Age-related macular degeneration. Prefferd practice pattern guideline. San Francisco, CA: American Academy of Ophthalmology; 2014.
Agarwal A, Rhoades WR, Hanout M, Soliman MK, Sarwar S, Sadiq MA, et al. Management of neovascular age-related macular degeneration: Current state-of-the-art care for optimizing visual outcomes and therapies in development. Clin Ophthalmol 2015; 9: 1001−15.
Rosenfeld PJ, Moshfeghi AA, Puliafito CA. Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging 2005; 36(4): 331−5.
Avery RL, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, Giust MJ. Intravitreal bevacizumab (Avastin) for age-related macular degeneration. Ophthalmology 2006; 113: 363−72. e5.
Bashshur ZF, Bazarbachi A, Schakal A, Haddad ZA, El Haibi CP, Noureddin BN. Intravitreal bevacizumab for the management of choroidal neovascularization in age-related macular degeneration. Am J Ophthalmol 2006; 142(1): 1−9.
Keane PA, Liakopoulos S, Chang KT, Wang M, Dustin L, Walsh AC, et al. Relationship between optical coherence tomography retinal parameters and visual acuity in neovascular age-related macular degeneration. Ophthalmology 2008; 115(12): 2206−14.
Kashani AH, Keane PA, Dustin L, Walsh AC, Sadda SR. Quantitative subanalysis of cystoid spaces and outer nuclear layer using optical coherence tomography in age-related macular degeneration. Invest Ophthalmol Vis Sci 2009; 50(7): 3366−73.
Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire MG, Ying GS, et al. Comparison of age-related macular degeneration treatments trials research group. Macular morphology and visual acuity in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2013; 120(9): 1860−70.
Wong IY, Iu LP, Koizumi H, Lai WW. The inner segment/outer segment junction: What have we learnt so far? Curr Opin Ophthalmol 2012; 23(3): 210−8.
Kwon YH, Lee DK, Kim HE, Kwon OW. Predictive findings of visual outcome in spectral domain optical coherence tomography after ranibizumab treatment in age-related macular degeneration. Korean J Ophthalmol 2014; 28(5): 386−92.
Tortotella P, Ambrosio E, Iannetti L, de Marco F, la Cava M. Correlation betwen visual acuity, inner segment/outer segment junction, and cone outer segment tips line integrity in uveitic macular edema. Biomed Res Int 2015: 853728.
Oishi A, Hata M, Shimozono M, Mandai M, Nishida A, Kurimoto Y. The significance of external limiting membrane status for visual acuity in age-related macular degeneration. Am J Ophthalmol 2010; 150(1): 27−32.e1.
Sayanagi K, Sharma S, Kaiser PK. Photoreceptor status after antivascular endothelial growth factor therapy in exudative age-related macular degeneration. Br J Ophthalmol 2009; 93(5): 622−6.
Hagan MJ, Alvarado JA, Weddell JE. Histology of the human eye: an atlas and textbook. Philadelphia: Saunders; 1971. p. 393−522.
Freund KB, Zweifel SA, Retina EM. Do we need a new classification for choroidal neovascularization in age-related macular degeneration? Retina 2010; 30(9): 1333−49.
Mathew R, Richardson M, Sivaprasad S. Predictive value of spectral-domain optical coherence tomography features in assessment of visual prognosis in eyes with neovascular age-related macular degeneration treated with ranibizumab. Am J Ophthalmology 2013; 155(4): 720−6, 726.e1.
Shin HJ, Chung H, Kim HC. Association between foveal microstructure and visual outcome in age-related macular degeneration. Retina 2011; 31(8): 1627−36.
Bloch SB, Lund-Andersen H, Sander B, Larsen M. Subfoveal fibrosis in eyes with neovascular age-related macular degeneration treated with intravitreal ranibizumab. Am J Ophthalmol 2013; 156(1): 116−24.