Enhanced depth imaging of the choroid in patients with neovascular age-related macular degeneration treated with anti-VEGF therapy versus untreated patients

  • Waheeda Rahman
  • Fred Kuanfu Chen
  • Jonathan Yeoh
  • Lyndon da Cruz
Retinal Disorders

Abstract

Purpose

To compare the subfoveal choroidal thickness (SFCT) between patients with neovascular age-related macular degeneration (nAMD) who had multiple intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents and those with treatment-naïve nAMD.

Methods

This retrospective case–control study included 15 patients in group 1 (nAMD in one eye which had received at least three anti-VEGF injections and early AMD in the fellow eye) and 15 patients in group 2 (newly diagnosed nAMD in one eye which had not received any treatment and early AMD in the fellow eye). They underwent enhanced depth imaging optical coherence tomography (OCT), and two OCT readers manually measured the SFCT. Inter-ocular difference in SFCT (nAMD eye minus fellow eye) was calculated for each patient.

Results

The nAMD eyes in group 1 had received a median (range) of four (3–8) intravitreal injections of anti-VEGF agents, and the OCT scans were performed at a median (range) of 9 (4–17) months after the first injection. The median inter-ocular difference in SFCT in groups 1 and 2 were not significantly different (13.5 and 3.0 μm in groups 1 and 2 respectively, p = 0.60). There was also no statistically significant difference in SFCT between nAMD and fellow eyes (p = 0.16), although there was a trend for greater median SFCT in the nAMD eyes.

Conclusion

The data from this small cohort suggests that no gross reduction in SFCT appears in nAMD patients after a time interval of at least 4 months between initiating repeated treatment with anti-VEGF therapy and OCT imaging. However, a study with a much larger sample size or longitudinal design is required to detect possible small fluctuations in SFCT in nAMD eyes receiving anti-VEGF therapy.

Keywords

Macular degeneration Enhanced depth imaging Optical coherence tomography Ranibizumab Bevacizumab Vascular endothelial growth factor Anti-VEGF 

Notes

Conflict of interest

The authors declare no conflict of interest.

Proprietary interests/funding

None

References

  1. 1.
    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 355:1432–1444PubMedCrossRefGoogle Scholar
  2. 2.
    Marneros AG, Fan J, Yokoyama Y, Gerber HP, Ferrara N, Crouch RK, Olsen BR (2005) Vascular endothelial growth factor expression in the retinal pigment epithelium is essential for choriocapillaris development and visual function. Am J Pathol 167:1451–1459PubMedCrossRefGoogle Scholar
  3. 3.
    Nishijima K, Ng YS, Zhong L, Bradley J, Schubert W, Jo N, Akita J, Samuelsson SJ, Robinson GS, Adamis AP, Shima DT (2007) Vascular endothelial growth factor-A is a survival factor for retinal neurons and a critical neuroprotectant during the adaptive response to ischemic injury. Am J Pathol 171:53–67PubMedCrossRefGoogle Scholar
  4. 4.
    Gaudreault J, Fei D, Beyer JC, Ryan A, Rangell L, Shiu V, Damico LA (2007) Pharmacokinetics and retinal distribution of ranibizumab, a humanized antibody fragment directed against VEGF-A, following intravitreal administration in rabbits. Retina 27:1260–1266PubMedCrossRefGoogle Scholar
  5. 5.
    Heiduschka P, Fietz H, Hofmeister S, Schultheiss S, Mack AF, Peters S, Ziemssen F, Niggemann B, Julien S, Bartz-Schmidt KU, Schraermeyer U (2007) Penetration of bevacizumab through the retina after intravitreal injection in the monkey. Invest Ophthalmol Vis Sci 48:2814–2823PubMedCrossRefGoogle Scholar
  6. 6.
    Schraermeyer U, Heiduschka P, Bartz-Schmidt KU (2009) Localisation of bevacizumab in the monkey retina after an intravitreal injection of Avastin. Ophthalmologe 106:619–624PubMedCrossRefGoogle Scholar
  7. 7.
    Peters S, Heiduschka P, Julien S, Ziemssen F, Fietz H, Bartz-Schmidt KU, Schraermeyer U (2007) Ultrastructural findings in the primate eye after intravitreal injection of bevacizumab. Am J Ophthalmol 143:995–1002PubMedCrossRefGoogle Scholar
  8. 8.
    Shimomura Y, Hirata A, Ishikawa S, Okinami S (2009) Changes in choriocapillaris fenestration of rat eyes after intravitreal bevacizumab injection. Graefes Arch Clin Exp Ophthalmol 247:1089–1094PubMedCrossRefGoogle Scholar
  9. 9.
    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(1):57–65PubMedCrossRefGoogle Scholar
  10. 10.
    McBain VA, Kumari R, Townend J, Lois N (2011) Geographic atrophy in retinal angiomatous proliferation. Retina 31:1043–1052PubMedCrossRefGoogle Scholar
  11. 11.
    Spaide RF, Koizumi H, Pozzoni MC (2008) Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol 146:496–500PubMedCrossRefGoogle Scholar
  12. 12.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedCrossRefGoogle Scholar
  13. 13.
    Sakurai K, Akiyama H, Shimoda Y, Yoshida I, Kurabayashi M, Kishi S (2009) Effect of intravitreal injection of high-dose bevacizumab in monkey eyes. Invest Ophthalmol Vis Sci 50:4905–4916PubMedCrossRefGoogle Scholar
  14. 14.
    Schraermeyer U, Julien S (2012) Formation of immune complexes and thrombotic microangiopathy after intravitreal injection of bevacizumab in the primate eye. Graefes Arch Clin Exp Ophthalmol 250(9):1303–1313, PMID:22614910PubMedCrossRefGoogle Scholar
  15. 15.
    Yamazaki T, Koizumi H, Yamagishi T, Kinoshita S (2012) Subfoveal choroidal thickness after ranibizumab therapy for neovascular age-related macular degeneration: 12-month results. Ophthalmology 119(8):1621–1627PubMedCrossRefGoogle Scholar
  16. 16.
    Spraul CW, Lang GE, Grossniklaus HE, Lang GK (1999) Histologic and morphometric analysis of the choroid, Bruch’s membrane, and retinal pigment epithelium in postmortem eyes with age-related macular degeneration and histologic examination of surgically excised choroidal neovascular membranes. Surv Ophthalmol 44(Suppl 1):S10–S32PubMedCrossRefGoogle Scholar
  17. 17.
    Ramrattan RS, van der Schaft TL, Mooy CM, de Bruijn WC, Mulder PG, de Jong PT (1994) Morphometric analysis of Bruch’s membrane, the choriocapillaris, and the choroid in aging. Invest Ophthalmol Vis Sci 35:2857–2864PubMedGoogle Scholar
  18. 18.
    Sarks SH (1976) Ageing and degeneration in the macular region: a clinico-pathological study. Br J Ophthalmol 60:324–341PubMedCrossRefGoogle Scholar
  19. 19.
    Rahman W, Chen FK, Yeoh J, Patel P, Tufail A, Da Cruz L (2011) Repeatability of manual subfoveal choroidal thickness measurements in healthy subjects using the technique of enhanced depth imaging optical coherence tomography. Invest Ophthalmol Vis Sci 52:2267–2271PubMedCrossRefGoogle Scholar
  20. 20.
    Margolis R, Spaide RF (2009) A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol 147:811–815PubMedCrossRefGoogle Scholar
  21. 21.
    Chen FK, Yeoh J, Rahman W, Patel PJ, Tufail A, Da Cruz L (2012) Topographic variation and interocular symmetry of macular choroidal thickness using enhanced depth imaging optical coherence tomography. Invest Ophthalmol Vis Sci 53(2):975–985PubMedCrossRefGoogle Scholar
  22. 22.
    Ikuno Y, Kawaguchi K, Nouchi T, Yasuno Y (2010) Choroidal thickness in healthy Japanese subjects. Invest Ophthalmol Vis Sci 51(4):2173–2176PubMedCrossRefGoogle Scholar
  23. 23.
    Chakraborty R, Read SA, Collins MJ (2011) Diurnal variations in axial length, choroidal thickness, intraocular pressure, and ocular biometrics. Invest Ophthalmol Vis Sci 52(8):5121–5129PubMedCrossRefGoogle Scholar
  24. 24.
    Esmaeelpour M, Povazay B, Hermann B, Hofer B, Kajic V, Kapoor K, Sheen NJ, North RV, Drexler W (2010) Three-dimensional 1060-nm OCT: choroidal thickness maps in normal subjects and improved posterior segment visualization in cataract patients. Invest Ophthalmol Vis Sci 51(10):5260–5266PubMedCrossRefGoogle Scholar
  25. 25.
    Ikuno Y, Tano Y (2009) Retinal and choroidal biometry in highly myopic eyes with spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci 50(8):3876–3880PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Waheeda Rahman
    • 1
  • Fred Kuanfu Chen
    • 2
    • 3
  • Jonathan Yeoh
    • 2
  • Lyndon da Cruz
    • 2
    • 3
  1. 1.Medical Retina ServiceMoorfields Eye HospitalLondonUK
  2. 2.Vitreo-retinal SurgeryMoorfields Eye HospitalLondonUK
  3. 3.NIHR BMRCMoorfields Eye HospitalLondonUK

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