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Antonio Polito, Emilia Maggio, Antonio Peroglio Deiro, Grazia Pertile; Predictors of Visual Outcome after Anti-VEGF Therapy of Neovascular Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5156.
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To study predictive factors for visual acuity after resolution of intra- and sub-retinal fluid following anti-VEGF therapy in patients with neovascular age related macular degeneration (AMD).
We studied retrospectively 53 eyes of 53 patients with resolved fluid after 3 monthly intravitreal ranibizumab for primary subfoveal or juxtafoveal neovascular AMD. On spectral domain optical coherence tomography, preoperative integrity of the foveal outer retina was studied using foveal thickness (FTH), external limiting membrane (ELM), and inner segment-outer segment (IS-OS) junction as a hallmark. The status of the ELM and IS-OS was classified as absent, disturbed or intact. Preoperative retinal parameters were correlated with the logarithm of minimal angle of resolution (logMAR) visual acuity at 3 months.
Intact ELM and IS-OS at baseline were present in 49% and 28%, respectively. Eighty-seven percent of eyes with intact IS-OS also had intact ELM, whereas only half of eyes with intact ELM had an intact IS-OS. In all eyes with absent ELM a disintegration of IS-OS was noted. Four weeks after the third injection, the number of eyes with intact IS/OS increased to 52% in eyes with preoperative intact and disturbed ELM, whereas it remained undetectable in eyes with preoperative absent ELM. The mean final visual acuity was 0.23 (+/- 0.23) and 0.24 (+/- 0.18) logMAR in eyes with preoperative intact and disturbed ELM, respectively, compared to 0.57 (+/- 0.34) logMAR in eyes with preoperative absent ELM (P<0.001, Figure). No correlation between preoperative FTH and final visual acuity could be found.
Preoperative ELM status may be more useful than is IS/OS status and foveal thickening in predicting retinal function following successful anti-VEGF therapy in patients with neovascular age related macular degeneration.
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