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C. I. Li Calzi, F. Coscas, S. Vismara, A. Zourdani, R. Zolf, G. Coscas; Outer Retinal Layers Alterations, Intra-Retinal Dense Areas, Hyper-Reflective Dots: Prognostic Value in the Follow-Up of Exudative AMD. Invest. Ophthalmol. Vis. Sci. 2009;50(13):939.
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Spectral Domain OCT imaging enables an analysis with high resolution of the retinal layers. The aim of this study was to analyse the morphologic modifications of the outer retinal layers including inflammatory reactions (Hyper-reflective dots and dense areas) as guidelines for initial and retreatment decisions in neovascular AMD and to correlate them with visual acuity (VA)
Series of 100 consecutive patients with neovascular AMD, were treated by intravitreal Anti-VEGF injections and followed monthly by biomicroscopy, fluorescein and indocyanine green (ICGA-SLO) angiographies and SD-OCT (Spectralis* Heidelberg) examinations. The mean follow-up was 12 months. The type of CNV was divided into five groups and were separately analyzed: 1-Occult CNV, (47%), 2-Classic CNV, (12,5%), 3-occult with classic CNV (20%), 4-Chorio Retinal Anastomosis (11,5%) and 5- Polypoïdal Choroidal Vasculopathy (9%). s Prognostic value and statistical correlation between visual acuity (VA), outer retinal layers modifications, and inflammatory reactions (hyper-reflective dots and dense areas) were evaluated.
Our series of 100 patients was analyzed after three injections: 66 % of them showed regression of the hyper-reflective dots, parallel to the outer retinal layers reorganization of the interface and External Limiting Membrane-ELM and improvement of VA; 24% showed hyper-reflective dots associated with retinal layers alterations/modifications of interface and ELM, progressive fibrosis and VA decreased; 10% of them: showed Cystoids degeneration
The presences of active CNV or the occurrence of recurrent CNV are associated with the persistence of hyper-reflective dots, dense zones and outer retinal layers alterations and are correlated well with VA decreased.However, the outer retinal layers reorganisation, hyper-reflective dots and dense/opaque zones indicate an effective treatment and give us information about the photoreceptor modification
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