Abstract
Purpose :
To find exudative AMD lesion components correlating with retinal sensitivity in patients treated with pro-re-nata (PRN) bevacizumab for 2 years.
Methods :
Fifty patients were prospectively analyzed in a 2-year study of bevacizumab treatment for exudative AMD. Visual acuity, fluorescein and indocyanine green (ICG) angiographies and autofluorescence images as well as microperimetry and OCTs recorded with Spectral OCT/SLO (OPKO/OTI) were analyzed. Reliable microperimetries and good quality OCTs from visits at baseline and at 1 and 2 years were available from 24 eyes of 24 patients and were included in the current analysis.
The microperimetries were automatically aligned with the OCTs and manually aligned with the angiographies and autofluorescence images. Thicknesses of the neuroretina, pigment epithelial (RPE) elevation (PEE), neuroepithelial detachment (NED), subretinal tissue (SRT) and cystoid spaces were manually measured under each stimulus site, and areas of classic and occult CNVs, ICG plaque, hemorrhage and RPE atrophy were identified.
Multivariate mixed linear models for repeated measurements were built to estimate the effects of lesion components on retinal sensitivity and to find the best predictors of retinal sensitivity during PRN treatment.
Results :
Retinal sensitivity increased during the first year (mean, baseline, 9.7 dB, 1 year, 10.7 dB, p<0.0001), but decreased during the second year (2 years, 10.5 dB, p=0.028). In the combined data of all visits the lesion components affecting retinal sensitivities were in a decreasing order of effect sizes (ES): the presences of RPE atrophy (ES 6.7), SRT (2.6), hemorrhage (2.4), cystoid spaces (2.4), classic (2.2) and occult CNVs (1.5) and neuroretinal thinning (1.2). The effects of PEE (0.96) and ICG plaque (0.69) were less pronounced. Baseline components associating with decreased retinal sensitivity at both 1 and 2 years were: the RPE atrophy, the area of classic CNV, presence of cystoid spaces, haemorrhage and occult CNV. Neuroretinal thickening, PEE and NED had lesser effects. Increasing age of the patient had a negative effect on the retinal sensitivities during the treatment.
Conclusions :
The most powerful predictors of retinal sensitivity loss during 2 years anti-VEGF treatment were the RPE atrophy, classic CNV, cystoid spaces and SRT. The occult CNV, PEE and NED had lesser effects.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.