Retinal Layers Changes in Patients with Age-related Macular Degeneration Treated with Intravitreal Anti-VEGF Agents

Overview

Journal BMC Ophthalmol

Publisher Biomed Central

Specialty Ophthalmology

Date 2023 Nov 12

PMID 37953270

Authors

Dan Zhou

Yan Hu

Zhongxi Qiu

Zirong Liu

Hongyang Jiang

Ryo Kawasaki

Jiang Liu

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of this study was to investigate retinal layers changes in patients with age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (anti-VEGF) agents and to evaluate if these changes may affect treatment response.

Methods: This study included 496 patients with AMD or PCV who were treated with anti-VEGF agents and followed up for at least 6 months. A comprehensive analysis of retinal layers affecting visual acuity was conducted. To eliminate the fact that the average thickness calculated may lead to differences tending to converge towards the mean, we proposed that the retinal layer was divided into different regions and the thickness of the retinal layer was analyzed at the same time. The labeled data will be publicly available for further research.

Results: Compared to baseline, significant improvement in visual acuity was observed in patients at the 6-month follow-up. Statistically significant reduction in central retinal thickness and separate retinal layer thickness was also observed (p < 0.05). Among all retinal layers, the thickness of the external limiting membrane to retinal pigment epithelium/Bruch's membrane (ELM to RPE/BrM) showed the greatest reduction. Furthermore, the subregional assessment revealed that the ELM to RPE/BrM decreased greater than that of other layers in each region.

Conclusion: Treatment with anti-VEGF agents effectively reduced retinal thickness in all separate retinal layers as well as the retina as a whole and anti-VEGF treatment may be more targeted at the edema site. These findings could have implications for the development of more precise and targeted therapies for AMD treatment.

References

Borrelli E, Barresi C, Lari G, Berni A, Battista M, Reibaldi M . Capturing the Transition From Intermediate to Neovascular AMD: Longitudinal Inner Retinal Thinning and Factors Associated With Neuronal Loss. Invest Ophthalmol Vis Sci. 2023; 64(4):21. PMC: 10132315. DOI: 10.1167/iovs.64.4.21. View

Mayer M, Hornegger J, Mardin C, Tornow R . Retinal Nerve Fiber Layer Segmentation on FD-OCT Scans of Normal Subjects and Glaucoma Patients. Biomed Opt Express. 2011; 1(5):1358-1383. PMC: 3018129. DOI: 10.1364/BOE.1.001358. View

Gemmy Cheung C, Lai T, Teo K, Ruamviboonsuk P, Chen S, Kim J . Polypoidal Choroidal Vasculopathy: Consensus Nomenclature and Non-Indocyanine Green Angiograph Diagnostic Criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup. Ophthalmology. 2020; 128(3):443-452. DOI: 10.1016/j.ophtha.2020.08.006. View

Lu Y, Huang W, Zhang Y, Huang X, Zhang X, Ma H . Factors for Visual Acuity Improvement After Anti-VEGF Treatment of Wet Age-Related Macular Degeneration in China: 12 Months Follow up. Front Med (Lausanne). 2021; 8:735318. PMC: 8632047. DOI: 10.3389/fmed.2021.735318. View

Valverde-Megias A, Ruiz-Calvo A, Murciano-Cespedosa A, Hernandez-Ruiz S, Martinez-de-la-Casa J, Garcia-Feijoo J . Long-term effect of intravitreal ranibizumab therapy on retinal nerve fiber layer in eyes with exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2019; 257(7):1459-1466. DOI: 10.1007/s00417-019-04325-y. View

Wichrowska M, Liberski S, Rzeszotarska A, Wichrowski P, Kociecki J . Examination of Inner Retinal Layers in Unilateral Wet Age-Related Macular Degeneration Treated with Anti-VEGF, Compared to Fellow Untreated Eyes. Int J Mol Sci. 2023; 24(1). PMC: 9820643. DOI: 10.3390/ijms24010402. View

Chakravarthy U, Harding S, Rogers C, Downes S, Lotery A, Culliford L . Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet. 2013; 382(9900):1258-67. DOI: 10.1016/S0140-6736(13)61501-9. View

Trinh M, Kalloniatis M, Alonso-Caneiro D, Nivison-Smith L . High-Density Optical Coherence Tomography Analysis Provides Insights Into Early/Intermediate Age-Related Macular Degeneration Retinal Layer Changes. Invest Ophthalmol Vis Sci. 2022; 63(5):36. PMC: 9150835. DOI: 10.1167/iovs.63.5.36. View

von der Emde L, Vaisband M, Hasenauer J, Bourauel L, Bermond K, Sassmannshausen M . Histologic Cell Shape Descriptors for the Retinal Pigment Epithelium in Age-Related Macular Degeneration: A Comparison to Unaffected Eyes. Transl Vis Sci Technol. 2022; 11(8):19. PMC: 9419462. DOI: 10.1167/tvst.11.8.19. View

10.

Sacconi R, Fragiotta S, Sarraf D, Sadda S, Freund K, Parravano M . Towards a better understanding of non-exudative choroidal and macular neovascularization. Prog Retin Eye Res. 2022; 92:101113. DOI: 10.1016/j.preteyeres.2022.101113. View

11.

Zucchiatti I, Battaglia Parodi M, Pierro L, Cicinelli M, Gagliardi M, Castellino N . Macular ganglion cell complex and retinal nerve fiber layer comparison in different stages of age-related macular degeneration. Am J Ophthalmol. 2015; 160(3):602-607.e1. DOI: 10.1016/j.ajo.2015.05.030. View

12.

Bo Q, Zhang M, Chen J, Jia H, Shen M, Sun M . Progression of Polypoidal Lesions Associated with Exudative Recurrence in Polypoidal Choroidal Vasculopathy. Ophthalmology. 2022; 130(2):167-178. DOI: 10.1016/j.ophtha.2022.09.013. View

13.

Wood A, Binns A, Margrain T, Drexler W, Povazay B, Esmaeelpour M . Retinal and choroidal thickness in early age-related macular degeneration. Am J Ophthalmol. 2011; 152(6):1030-1038.e2. DOI: 10.1016/j.ajo.2011.05.021. View

14.

Wallsh J, Gallemore R . Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options. Cells. 2021; 10(5). PMC: 8145407. DOI: 10.3390/cells10051049. View

15.

Kanagasingam Y, Bhuiyan A, Abramoff M, Smith R, Goldschmidt L, Wong T . Progress on retinal image analysis for age related macular degeneration. Prog Retin Eye Res. 2013; 38:20-42. DOI: 10.1016/j.preteyeres.2013.10.002. View

16.

Resch M, Balogh A, Kurth T, Nagy Z, DeBuc D, Papp A . Atrophy of retinal vessels in neovascular age-related macular degeneration following long-term treatment with 20 intravitreal anti-VEGF injections. BMC Ophthalmol. 2022; 22(1):469. PMC: 9721060. DOI: 10.1186/s12886-022-02700-8. View

17.

Fenner B, Ting D, Tan A, Teo K, Chan C, Mathur R . Real-World Treatment Outcomes of Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy in Asians. Ophthalmol Retina. 2020; 4(4):403-414. DOI: 10.1016/j.oret.2019.10.019. View

18.

Kim S, Yoon M, Chin H . Changes in the Ganglion Cell-inner Plexiform Layer after Consecutive Intravitreal Injections of Anti-vascular Endothelial Growth Factor in Age-related Macular Degeneration Patients. Korean J Ophthalmol. 2020; 34(1):11-18. PMC: 7010477. DOI: 10.3341/kjo.2019.0081. View

19.

Mettu P, Allingham M, Cousins S . Incomplete response to Anti-VEGF therapy in neovascular AMD: Exploring disease mechanisms and therapeutic opportunities. Prog Retin Eye Res. 2020; 82:100906. PMC: 10368393. DOI: 10.1016/j.preteyeres.2020.100906. View

20.

Penn J, Madan A, Caldwell R, Bartoli M, Caldwell R, Hartnett M . Vascular endothelial growth factor in eye disease. Prog Retin Eye Res. 2008; 27(4):331-71. PMC: 3682685. DOI: 10.1016/j.preteyeres.2008.05.001. View