Retinal Pigment Epithelium Atrophy in Patients Receiving Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration

Abstract

 

Purpose

 

To examine factors associated with the progression of retinal pigment epithelium (RPE) atrophy in treatment naïve eyes with neovascular age-related macular degeneration (AMD) using combined confocal scanning laser ophthalmoscope (cSLO) near-infrared reflectance (IR) and Spectralis eye-tracked spectral-domain optical coherence tomography (SD-OCT).

 

Methods

 

We retrospectively analyzed a consecutive series of patients with newly diagnosed neovascular AMD who initiated intravitreal anti-vascular endothelial growth factor therapy from January 2006 to November 2011. Inclusion criteria were age over 50 years, best corrected visual acuity of 20/40 to 20/800, new onset of treatment-naïve CNV, absence of permanent structural damage to the central fovea, baseline IR and SD-OCT imaging at diagnosis and a minimum of 12-months of follow-up. Two independent graders measured areas of RPE atrophy identified using combined IR and eye-tracked SD-OCT at baseline and last follow up. The RPE atrophy progression rate was calculated. The neovascular lesion subtypes were classified based on both fluorescein angiography and SD-OCT as type 1 (subRPE), 2 (subretinal), 3 (intraretinal) or 4 (mixed). The RPE atrophy progression rate was correlated to the lesion subtype. The RPE atrophy progression rate was also evaluated in fellow dry eyes for the purpose of comparison.

 

Results

 

Among the 748 cases reviewed, 153 patients (103 eyes) fit the inclusion criteria. The mean patient age was 81 years with a mean follow up duration of 31 months. The mean progression rate of RPE atrophy was 0.8 mm²/year (range 0 - 6.3 mm²/year). There were 43 patients who had a fellow dry AMD eye. The mean RPE atrophy progression rate in the fellow dry eyes was 0.3 mm²/year (range 0 - 1.99 mm²/year), significantly less than in the treated CNV eyes (p<0.05). In the eyes with neovascular AMD, the RPE atrophy progression rate varied by lesion subtype, and eyes with type 3 (RAP) lesions had the highest rate of progression of RPE atrophy (p<0.05).

 

Conclusions

 

The RPE atrophy progression rate in treatment naïve CNV eyes was similar to what has been previously reported in geographic atrophy in dry AMD, but this rate was higher than in the fellow dry eyes. Eyes with type 3 (RAP) lesions had the highest rate of progression of RPE atrophy compared to other neovascular lesion subtypes.

 

Keywords: 412 age-related macular degeneration • 453 choroid: neovascularization • 701 retinal pigment epithelium