First Author: V.Castro Navarro SPAIN
Co Author(s): E. Cervera Taulet C. Navarro-Palop J. Montero-Hernandez L. Hernandez-Bel
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Imaging methods have become increasingly sensitive, allowing better detection of anatomical changes in exudative and degenerative stages of neovascular age-related-macular degeneration. This has encouraged multimodal evaluation for choroidal neovascularization (CNV) and the discovery of several anatomical landmarks that may influence visual outcome, which include the presence of intraretinal or subretinal fluid, the integrity of the external limiting membrane (ELM), or the restoration of the ellipsoid zone (EZ). Our objective is to analyze changes in retinal and choroidal biomarkers with spectral-domain optical coherence tomography (SD-OCT) in exudative-AMD and to correlate the findings with visual outcome.
Retrospective nonrandomized cohort study. Thirty-seven eyes of patients with exudative-naive- AMD; 11 classic CNV, 12 occult CNV, 7 mixed CNV and 8 retinal angiomatous proliferations (RAP) lesions were analyzed.
Patients were treated with three monthly intravitreal aflibercept (2 mg) injections, followed by a T&E regimen. Main outcome measures included changes in BCVA (LogMAR) and quantitative and qualitative analysis with SD-OCT of morphological parameters recorded at baseline and at 12 months. Morphological analyses included central macular thickness (CMT), macular volume (MV), integrity of ELM and EZ measured at 1000 µ centreed on fovea, and choroidal thickness (CT) measured at 500 µ centreed on fovea. If present, pigment epithelium detachment (PED) height was measured at its maximum height, and at 500µ centreed on fovea. Statistical significance was defined as (p<0.05).
Regarding functional outcomes BCVA significantly improved from 0.60 ± 0.27 LogMAR to 0.40 ± 0.34 LogMAR. Analysis of the morphological features at 12 month showed a positive statistical significant correlation between baseline CMT (R=0.26; p=0.001) and PED height measured at its maximum height (R=0.22; p=0.005) and at 500µ nasal (R=0.26; p=0.001) or 500µ temporal to fovea (R=0.17; p=0.03) with final LogMAR BCVA. Additionally, a significant negative relationship was found between baseline integrity in MLE (R=-0.42; p=0.0000008) and EZ (R=-0.50; p=0.000007) and final LogMAR BCVA. No correlations were found between, VM or CT and visual outcomes (p≥0.05).
Qualitative and quantitative morphological features obtained by advanced OCT provide novel insight into exudative AMD. Our findings indicate that several anatomical biomarkers such as CMT, PED height or the status of outer retinal layers may have an impact in visual prognosis. Among them, the strongest predictor of final BCVA seems to be the integrity of ZE measured in the central 1000µ.