An association between RPE disruption and fibrotic scar formation after aflibercept therapy for neovascular age-related macular degeneration

Abstract

Purpose : Appearance of subretinal fibrotic scar (SRF) is predicted by specific features on optical coherence tomography (OCT). We performed a retrospective, observational clinical study to investigate an association between disruption of retinal pigment epithelium (RPE) layer and SRF formation after aflibercept therapy in patients with neovascular age-related macular degeneration (nAMD).

Methods : This study enrolled 102 eyes from 97 patients with naïve nAMD. All patients who had spectral OCT (Spectralis, Heidelberg Engineering) at baseline and underwent intravitreal aflibercept treatment based on treat and extend regimen. RPE disruptions at baseline on OCT were quantified by measuring average lengths of disruption of normal RPE layers in vertical and horizontal lines scanning the center of choroidal neovascular lesions. Subretinal fibrotic scar was determined on multimodal imaging, including color fundus and OCT at 6 months.

Results : At baseline, RPE disruptions were found in 53 eyes (52.0%); RPE disruption lengths less than 500 μm (partial disruption) were found in 30 eyes (29.4%) and those more than 500 µm (widespread disruption) were in 23 eyes (22.5%). Among the eyes with widespread RPE disruption, 18 eyes (78%) developed fibrotic scar; in contrast, none of the eyes without and with partial RPE disruption developed fibrotic scar by 6 months. The average length of RPE disruption at baseline was significantly longer in the eyes that developed fibrotic scar than those without fibrotic scar.

Conclusions : Widespread disruption of RPE layer can be a tomographic biomarker predicting fibrotic scar formation after aflibercept therapy for nAMD.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.