Peripapillary RNFL thickness in nonexudative versus chronically treated exudative age-related macular degeneration

To compare the peripapillary retinal nerve fibre layer (RNFL) thickness in nonexudative versus exudative age-related macular degeneration (wet AMD) eyes treated chronically with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF).

Cross-sectional study.

Twenty-nine patients with unilateral wet AMD with at least 12 prior intravitreal anti-VEGF injections and 2 years of therapy were analyzed. The fellow eye with nonexudative (dry) AMD with no prior treatment served as the control group.

All patients were prospectively enrolled from a single academic subspecialist practice. Bilateral spectral-domain optical coherence tomography (Cirrus SD-OCT; Carl Zeiss Meditec, Dublin, Calif.) of the peripapillary RNFL was performed on all pairs of eyes. Optic nerve head (ONH) parameters were also computed. The primary outcome was mean difference in peripapillary RNFL thickness compared between the treated and the nontreated eyes.

Mean RNFL in the chronically treated eyes (95.0 [95% CI 89.8-100.2] μm) was significantly greater than the nontreated fellow eyes (89.9 [95% CI 85.5-94.3] μm) (p = 0.01). Quadrantic optic nerve analysis revealed the temporal RNFL to be greater in the treated group (p = 0.02), whereas all other locations were similar. No significant differences were found between the 2 groups in any ONH parameters.

This study demonstrated no deleterious optic nerve RNFL thinning in a series of wet AMD eyes with long-term repetitive exposure to intravitreal anti-VEGF injections. Furthermore, we observed that those with wet AMD have a relatively thickened temporal peripapillary RNFL layer, which is an important association for all observers of optic nerve disease.