Abstract
Purpose
To evaluate whether the status of the external limiting membrane (ELM) or inner segment/outer segment junction (IS/OS) improves after intravitreal injection of ranibizumab for age-related macular degeneration (AMD). We also evaluated whether the pre-operative values of these parameters are associated with the visual prognosis.
Methods
This was a hospital-based, cross-sectional study. Seventy-six eyes of 76 treatment-naive AMD patients who received three monthly intravitreal injections of ranibizumab followed for more than 6 months with additional as-needed injections were investigated. Spectral domain OCT was used to evaluate the length of ELM, IS/OS, and foveal thickness pre- and post-operatively. Changes of ELM and IS/OS length were evaluated postoperatively. Correlation coefficients between pre-operative parameters and post-operative visual acuity were also analyzed.
Results
Significant changes were noted in mean logMAR (0.66 to 0.53), foveal thickness (231.1 to 151.1 μm), and IS/OS length (514.9 to 832.3 μm) after the treatment. ELM length did not improve significantly (1,312.4 to 1,376.7 μm). Restoration of IS/OS occured where ELM is retained. Although pre-operative ELM length, IS/OS length, and foveal thickness showed correlation with post-operative logMAR (R = –0.51, –0.39, and 0.46, respectively), the most powerful predictive factor for visual prognosis was pre-operative logMAR (R = 0.77, p < 0.001).
Conclusions
IS/OS status improves in response to anti-VEGF therapy but ELM seems to have less plasticity. The status of IS/OS and ELM can be used as prognostic factors but the predictive power is inferior to that of baseline visual acuity.
Similar content being viewed by others
References
Coker JG, Duker JS (1996) Macular disease and optical coherence tomography. Curr Opin Ophthalmol 7:33–38
Salinas-Alamán A, Garcia-Layana A, Maldonado MJ, Sainz-Gomez C, Alvarez-Vidal A (2005) Using optical coherence tomography to monitor photodynamic therapy in age-related macular degeneration. Am J Ophthalmol 140:23–28
Kashani AH, Keane PA, Dustin L, Walsh AC, Sadda SR (2009) Quantitative subanalysis of intraretinal cystoid spaces and outer nuclear layer using optical coherence tomography in neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci 50:3366–3373
Landa G, Bukelman A, Katz H, Pollack A (2009) Early OCT changes of neuroretinal foveal thickness after first versus repeated PDT in AMD. Int Ophthalmol 29:1–5
Keane PA, Liakopoulos S, Jivrajka RV, Chang KT, Alasil T, Walsh AC, Sadda SR (2009) Evaluation of optical coherence tomography central retinal thickness parameters for use as anatomic outcomes in clinical trials for neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci 50:3378–3385
Drexler W, Sattmann H, Hermann B, Ko TH, Stur M, Unterhuber A, Scholda C, Findl O, Wirtitsch M, Fujimoto JG, Fercher AF (2003) Enhanced visualization of macular pathology with the use of ultrahigh-resolution optical coherence tomography. Arch Ophthalmol 121:695–706
Ko TH, Fujimoto JG, Schuman JS, Paunescu LA, Kowalevicz AM, Hartl I, Drexler W, Wollstein G, Ishikawa H, Duker JS (2005) Comparison of ultrahigh- and standard-resolution optical coherence tomography for imaging macular pathology. Ophthalmology 112:1922
Hayashi H, Yamashiro K, Tsujikawa A, Ota M, Otani A, Yoshimura N (2009) Association between foveal photoreceptor integrity and visual outcome in neovascular age-related macular degeneration. Am J Ophthalmol 148:83–89
Sayanagi K, Sharma S, Kaiser PK (2009) Photoreceptor status after antivascular endothelial growth factor therapy in exudative age-related macular degeneration. Br J Ophthalmol 93:622–626
Landa G, Su E, Garcia PM, Seiple WH, Rosen RB (2011) Inner segment-outer segment junctional layer integrity and corresponding retinal sensitivity in dry and wet forms of age-related macular degeneration. Retina 31:364–370
Oishi A, Hata M, Shimozono M, Mandai M, Nishida A, Kurimoto Y (2010) The significance of external limiting membrane status for visual acuity in age-related macular degeneration. Am J Ophthalmol 150:27–32
Coscas G, Coscas F, Vismara S, Zourdani A, Li Calzi C (2009) OCT interpretation. In: Coscas G, Coscas F, Vismara S, Zourdani A, Li Calzi C (eds) Optical coherence tomography in age-related macular degeneration. Springer, Berlin Heidelberg New York, pp 97–170
Coscas G, Coscas F, Vismara S, Zourdani A, Li Calzi C (2009) Clinical features and natural history of AMD. In: Coscas G, Coscas F, Vismara S, Zourdani A, Li Calzi C (eds) Optical coherence tomography in age-related macular degeneration. Springer, Berlin Heidelberg New York, pp 171–274
Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419–1431
Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S (2006) Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 355:1432–1444
Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T (2009) Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study. Ophthalmology 116:57–65
Oishi A, Mandai M, Nishida A, Hata M, Matsuki T, Kurimoto Y (2011) Remission and dropout rate of anti-VEGF therapy for age-related macular degeneration. Eur J Ophthalmol 21:777–782
Bressler NM (2009) Antiangiogenic approaches to age-related macular degeneration today. Ophthalmology 116:S15–S23
Golbaz I, Ahlers C, Stock G, Schutze C, Schriefl S, Schlanitz F, Simader C, Prunte C, Schmidt-Erfurth UM (2011) Quantification of the therapeutic response of intraretinal, subretinal, and subpigment epithelial compartments in exudative AMD during anti-VEGF therapy. Invest Ophthalmol Vis Sci 52:1599–1605
Brown DM, Regillo CD (2007) Anti-VEGF agents in the treatment of neovascular age-related macular degeneration: applying clinical trial results to the treatment of everyday patients. Am J Ophthalmol 144:627–637
Sung CH, Chuang JZ (2010) The cell biology of vision. J Cell Biol 190:953–963
Shimozono M, Oishi A, Hata M, Kurimoto Y (2011) Restoration of the photoreceptor outer segment and visual outcomes after macular hole closure: spectral-domain optical coherence tomography analysis. Graefes Arch Clin Exp Ophthalmol 249:1469–1476
Chiang A, Chang LK, Yu F, Sarraf D (2008) Predictors of anti-VEGF-associated retinal pigment epithelial tear using FA and OCT analysis. Retina 28:1265–1269
Moroz I, Moisseiev J, Alhalel A (2009) Optical coherence tomography predictors of retinal pigment epithelial tear following intravitreal bevacizumab injection. Ophthalmic Surg Lasers Imaging 40:570–575
Singh RP, Fu EX, Smith SD, Williams DR, Kaiser PK (2009) Predictive factors of visual and anatomical outcome after intravitreal bevacizumab treatment of neovascular age-related macular degeneration: an optical coherence tomography study. Br J Ophthalmol 93:1353–1358
Byun YJ, Lee SJ, Koh HJ (2010) Predictors of response after intravitreal bevacizumab injection for neovascular age-related macular degeneration. Jpn J Ophthalmol 54:571–577
Unver YB, Yavuz GA, Bekiroglu N, Presti P, Li W, Sinclair SH (2009) Relationships between clinical measures of visual function and anatomic changes associated with bevacizumab treatment for choroidal neovascularization in age-related macular degeneration. Eye (Lond) 23:453–460
Keane PA, Liakopoulos S, Chang KT, Wang M, Dustin L, Walsh AC, Sadda SR (2008) Relationship between optical coherence tomography retinal parameters and visual acuity in neovascular age-related macular degeneration. Ophthalmology 115:2206–2214
Shimozono M, Oishi A, Hata M, Matsuki T, Ito S, Ishida K, Kurimoto Y (2012) The significance of cone outer segment tips as a prognostic factor in epiretinal membrane surgery. Am J Ophthalmol. doi:10.1016/j.ajo.2011.09.011
Acknowledgments
The study was supported in part by a Grant-In-Aid for Scientific Research (No. 22791706) from the Japanese Society for the Promotion of Science, Tokyo. Financial disclosures: none.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have no proprietary interest in any aspect of this study.
Rights and permissions
About this article
Cite this article
Oishi, A., Shimozono, M., Mandai, M. et al. Recovery of photoreceptor outer segments after anti-VEGF therapy for age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 251, 435–440 (2013). https://doi.org/10.1007/s00417-012-2034-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-012-2034-4