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David Xu, Sumit Sharma, Siya Huo, Jack Shao, Peter Kaiser; Continuity of the Photoreceptor Inner/outer Segment Junction and Visual Acuity in Anti-VEGF Therapy for Exudative AMD. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1760.
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To evaluate the continuity of the photoreceptor inner/outer segment (IS/OS) and thickness of the photoreceptor layer in patients with exudative age-related macular degeneration (AMD) and to investigate the relationship between IS/OS continuity, photoreceptor thickness, and visual outcome.
A total of 99 eyes of 99 patients undergoing anti-vascular endothelial growth factor (anti-VEGF) monotherapy for exudative AMD were enrolled in this retrospective case series study. Anti-VEGF therapy was administered to patients on an as-needed basis guided by ophthalmic examination, visual acuity, and spectral domain optical coherence tomography (SD-OCT) findings. OCT scans were analyzed to extract measurements of retinal and photoreceptor morphology. Clinical measures were retrospectively analyzed to extract Snellen visual acuity, anti-VEGF injection history, and patient demographics.
The mean ± SD age was 80.7 ± 9.1 years. Patients underwent a mean of 11.2 ± 8.8 injections over 25.0 ± 17.6 months. At conversion to exudative disease, patients had a mean VA of .572 ± .379 (logarithm of the minimum angle of resolution [logMAR], 20/75 Snellen equivalent). At the time of study, patients had a mean VA of .487 ± .349 (logMAR, 20/60 Snellen equivalent). Age (p=.0390), photoreceptor thickness (p=.0323), baseline BCVA (p=.0046), and BCVA at time of study (p=.0001) were significantly different between patients with continuous and non-continuous IS/OS segment. More discontinuous IS/OS segment grading was associated with advanced age (p=.0390), thinner photoreceptor layer thickness (p=.0323), and worse baseline (p=.0046) and final (p=.0001) visual acuity. Advanced age (p=.0018) and decreased photoreceptor layer thickness (p=.0359) was correlated with worse final BCVA.
Continuity of the photoreceptor IS/OS segment and increased photoreceptor thickness seen in SD-OCT are protective of visual acuity in patients undergoing anti-VEGF therapy for exudative AMD.
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