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Long-term changes in retinal layers in patients undergoing intravitreal ranibizumab for neovascular age-related macular degeneration

Retinal layers after anti-VEGF therapy

Abstract

Purpose

To analyze long-term changes in individual retinal layers (RLs) after intravitreal injections of ranibizumab (IVRs) in patients with neovascular age-related macular degeneration (n-AMD).

Methods

The patients were treated with 0.5-mg IVRs based on an as-needed protocol after the first three monthly doses over a 12-month follow-up period. Patients underwent optical coherence tomography and best-corrected visual acuity (BCVA) evaluation at each visit. The ETDRS grid with central subfield (R1) (r 0.5 mm) and the inner ring (R2) (r 0.5–1.5 mm) was used for calculation of the mean thickness of each RL. Changes in the thickness of segmented RLs within the R1 and R2 of ETDRS circles at months-3, -6, and -12 were compared to baseline.

Results

The mean age was 72 ± 7.4 years. The mean number of injections was 9.08 (range 6–11). Mean BCVA improved from 49.7 ± 22.1 to 60.1 ± 19.8 letters. Central macular thickness decreased from 390.25 ± 149.6 to 312.74 ± 118.4 μm. Thicknesses of GCL (from 23.93 ± 13.73 to 19.50 ± 9.50 μm in R1; p 0.001, and from 44.5 ± 12.6 to 39.6 ± 10.6 μm in R2; p 0.005), IPL (from 28.90 ± 14.36 to 22.35 ± 6.23 μm in R1; p 0.001, and from 39.34 ± 8.53 to 35.58 ± 7.93 μm in R2; p 0.004), and total inner RL (ILM to ELM) (from 222.93 ± 93.09 to 180 ± 53 μm in R1; p 0.001, and from 255.06 ± 42.74 to 240.25 ± 40.37 μm in R2; p 0.003) in the central and parafoveal rings decreased statistically at month-12. Decrease in INL was limited to month-6 (from 34.80 ± 15.33 to 27.60 ± 12.59 μm in R1; p 0.001), while decreases in total outer RLs (ELM to RPE) (from 128.32 ± 26.92 to 115.54 ± 43.98 μm in R1; p 0.001, and 103.81 ± 16.73 to 96.38 ± 16.22 μm in R2; p 0.014) and RPE (from 39.12 ± 22.33 to 29.70 ± 22.05 μm in R1; p 0.001, and from 31.27 ± 13.11 to 24.40 ± 9.99 μm in R2; p 0.001) were limited to month-3.

Conclusions

Significant changes were observed in the thickness of the inner RLs after 1-year treatment with IVRs for n-AMD. A significant decrease in RPE thickness confined to the first months disappeared at month-12.

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Funding

This study was supported in part by a Grant from Afyon Kocatepe University Scientific Research Projects Committee with Project No. 14.TUS.12.

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Correspondence to Sibel Inan.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Ümit Übeyt Inan, Zeki Baysal, Sibel Inan are formerly at Kocatepe University Medical School Department of Ophthalmology, Afyon, Turkey.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplemental Figure

 1. Demonstration of retinal segmentation in a patient with neovascular age-related macular degeneration at baseline (top) and month-12 after intravitreal ranibizumab treatment (bottom). Segmentation of retinal layers in a representative case. (JPEG 18536 kb)

Supplemental Digital Content 2:

Supplemental Table 1. RNFL and GCL.doc: Baseline Values and Change during follow-up in the thicknesses of RNFL and GCL (DOCX 15 kb)

Supplemental Digital Content 3:

Supplemental Table 2. IPL and INL.doc: Baseline Values and Change during follow-up in the thicknesses of IPL and INL (DOCX 16 kb)

Supplemental Digital Content 4:

Supplemental Table 3. OPL and ONL.doc: Baseline Values and Change during follow-up in the thicknesses of OPL and ONL (DOCX 15 kb)

Supplemental Digital Content 5:

Supplemental Table 4. IRLs and ORL.doc: Baseline Values and Change during follow-up in the thicknesses of IRL and ORL (DOCX 16 kb)

Supplemental Digital Content 6:

Supplemental Table 5. RPE.doc: Baseline Values and Change during follow-up in the thicknesses of RPE (DOCX 14 kb)

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Inan, Ü.Ü., Baysal, Z. & Inan, S. Long-term changes in retinal layers in patients undergoing intravitreal ranibizumab for neovascular age-related macular degeneration. Int Ophthalmol 39, 2721–2730 (2019). https://doi.org/10.1007/s10792-019-01116-6

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  • DOI: https://doi.org/10.1007/s10792-019-01116-6

Keywords

  • Neovascular age-related macular degeneration
  • Macular edema
  • Retinal layers
  • Retinal segmentation