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Florence Coscas, Gabriel J Coscas, Ali Dirani, Marco Lupidi, Mayer Srour, Oudy Semoun, Catherine Français, Eric H Souied; Recovery Of Ellipsoid Zone After Aflibercept Therapy For Exudative Age-Related Macular Degeneration.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5384.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the disruption of foveal Ellipsoid Zone (EZ) and External Limiting Membrane (ELM) following intravitreal Aflibercept (IAI) treatment in eyes with exudative age-related macular degeneration (eAMD) naïve to treatment, and to correlate these changes to visual recovery and to fluid response.
This is a retrospective case series of 51 treatment naïve eAMD eyes that received IAI and were followed for 12 months. All patients underwent measurement of best-corrected visual acuity (BCVA) (Early Treatment Diabetic Retinopathy Study ETDRS scale), spectral-domain optical coherence tomography, fluorescein and indocyanine green angiographies at baseline, week 16, 24 and 52. The disruption of EZ and ELM (including loss of continuity, swelling of EZ and sub hyper-reflective material [SHM]), were evaluated at baseline and at 12 months, and correlated with BCVA, central macular thickness (CMT), at baseline and at 12 months.
Mean number of injections: 7.4 in 12 months. BCVA (+ 6.6 letters, p=0.009), EZ continuity,and ELM continuity improved significantly at 12 months (p=0.001 for each). Improvement in Visual acuity post treatment was associated to decrease in CMT, regression of fluid and recovery of EZ and ELM, The absence of intraretinal cystoid spaces at baseline OCT was correlated with better EZ and ELM continuity at 12 months. In multivariate analysis, EZ improvement at 12 months was correlated with a higher baseline BCVA (p=0.003), baseline SRF (p=0.007) and baseline absence of cystoid spaces (p= 0.035). ELM improvement at 12 months was associated with baseline ELM continuity (p: 0.001, r=0.6) and baseline absence of cystoid spaces (p= 0.011). In the group of patients with dry macula who gained 5 or more ETDRS letters at 12 months (37 out of 51), the ELM disruption was significantly compared to patients who had stable or decreased VA (p=0.03).
Changes of outer retinal layers could recover after anti-VEGF treatment in wet AMD. The final BCVA is correlated to the initial status of ELM (p=0.001). Changes of the EZ may partially regress after treatment, but could be associated with irreversible decrease in vision. Then baseline changes of EZ and ELM must be analyzed for the evaluation of the prognosis.
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