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Published on: January 21, 2018
Longitudinal Changes in Inner Retinal Layers in Treatment-Naïve Neovascular Age-Related Macular Degeneration during
Helin Kardo1, Richard A Garweg2, Lars Imbach3
1Berner Augenklinik, Bern, Switzerland; Swiss Eye Institute, Rotkreuz, Switzerland; Department of Ophthalmology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Purpose:
To investigate longitudinal changes in retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness in treatment-naïve neovascular age-related macular degeneration (nAMD) under intravitreal anti-VEGF therapy compared with untreated fellow eyes with dry AMD (dAMD).
Design:
Retrospective single-center cohort study.
Subjects:
Consecutive patients with treatment-naïve nAMD receiving anti-VEGF therapy under a treat-and-extend regimen and a minimum follow-up of 24 months were included. Untreated fellow eyes with dAMD served as controls.
Methods:
Retinal nerve fiber layer and GC-IPL thickness were assessed longitudinally using spectral-domain OCT and RetinAI analysis. Best-corrected visual acuity (BCVA) and structural retinal changes were evaluated over time. Linear mixed-effects models were used to assess factors associated with retinal layer changes.
Main Outcome Measures:
Longitudinal changes in RNFL thickness, GC-IPL thickness, and BCVA.
Results:
In nAMD eyes, median RNFL thickness in the 3 mm ring zone decreased from 32.3 μm (30.1-35.4 μm) at baseline to 30.9 μm (29.0-33.4 μm; adjusted P < 0.001) after the loading phase and remained stable thereafter (all adjusted P > 0.05), with a similar pattern observed in fellow dAMD eyes. In contrast, GC-IPL thickness progressively declined in both groups. In nAMD eyes, median GC-IPL thickness decreased from 89.1 μm (81.9-94.9 μm) at baseline to 85.1 μm (77.7-90.2 μm) after loading (adjusted P < 0.001), followed by continued thinning throughout follow-up. BCVA in nAMD eyes improved after loading with a median gain of 4.8 ETDRS letters (0-10.2 ETDRS letters; adjusted P < 0.001), remained stable for up to 3 years, and gradually declined thereafter. Mixed-effects modeling showed that RNFL thickness was associated with injection number, whereas GC-IPL loss was associated with age and follow-up duration, independent of injection number or sex.
Conclusions:
The regression in RNFL and GC-IPL thickness during the loading phase in eyes with nAMD may reflect the resolution of pre-treatment swelling. Retinal nerve fiber layer thickness remained stable thereafter, whereas GC-IPL thickness and BCVA declined after loading similarly to fellow eyes with dAMD. According to the mixed-effects model, GC-IPL thinning appears linked to progression of the underlying degenerative process, whereas RNFL thickness appears comparatively preserved.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
