Abstract
Purpose :
To demonstrate and evaluate the qualitative and quantitative response of multilayered fibrovascular pigment epithelial detachment (PED) to anti-vascular endothelium growth factor (VEGF) injections in age-related macular degeneration (AMD).
Methods :
We analyzed retrospectively the qualitative and quantitative changes of 30 eyes with exudative AMD showing fibrotic multilayered PED, between 2 consecutive visits. All patients had one anti-VEGF intravitreal injection between visits. We quantitatively analyzed the different compartments within the fibrotic tissue and their therapeutic response.
Results :
The mean follow up time interval between the 2 consecutive visits was 50 ±31.72 days (range 17 - 134 days). We defined 3 OCT zones within the fibrotic tissue: an inhomogeneous hypo-reflective space under the RPE (layer 1), a hyper-reflective band beneath layer 1 (layer 2), and a hypo-reflective space between the Bruch’s membrane and layer 2 (layer 3). The mean height of layer 1 was 144.86 ±46.76mm and 103.50 ±41.50mm at visit 1 and 2 respectively (a mean change of -41.36±24.06mm; p < 0.0001). The mean thickness of layer 2 was 102.93 ±44.97mm and 85.06 ±35.16mm at visit 1 and 2 respectively (a mean change of -17.86±19.50mm; p < 0.0001). The mean height of layer 3 (detectable in a total of only 10/30 eyes) was 34.3±31.25mm and 6.0 ±8.25mm at visit 1 and 2 respectively (p = 0.0058). The mean height change for layer 1 was statistically significantly higher than the change for layer 2 (p < 0.0001). The mean change of layer 3 compared to layer 1 and layer 2 had no statistical difference (p = 0.24 and p = 0.44 respectively).
Conclusions :
In our analysis, the fibrovascular PED was compartmented into 3 layers with different reflectivities that respond differently to anti-VEGF injections. All 3 layers showed a good therapeutic response, however, layer 2 had a statistically significantly lower response compared to layer 1, supporting the hypothesis of a fibrotic component in layer 2.
This is a 2020 ARVO Annual Meeting abstract.