First Author: V.Castro Navarro SPAIN
Co Author(s): E. Cervera Taulet J. Montero-Hernandez C. Navarro-Palop L. Hernandez-Bel
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The continued development of diagnostic methods has allowed more precise visualization of anatomical structures. This has encouraged multimodal classifications for choroidal neovascularization (CNV) and the discovery of several anatomical landmarks that may influence visual outcome. Our objective is to analyze functional and morphological changes in different choroidal neovascular membranes in age- related macular degeneration (AMD) treated with aflibercept during 12 months according to a treat-and-extend (TAE) regimen .
Retrospective nonrandomized cohort study. Thirty-seven eyes of patients with exudative 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 2 mg aflibercept injections followed by a TAE approach. According the multimodal in vivo imaging classification proposed by Freund and build on Donald Gass’ histologic classification the study group was divided into four subgroups according to the : a) type 1 CNV, b) type 2 CNV c) a mixed typical subfoveal choroidal membrane lesions and d) the RAP group. Main outcome measures included changes in BCVA and quantitative and qualitative analysis with fluorescein angiography and Spectral-domain optical coherence tomography (SD-OCT) of morphological parameters in each subtype of CNV recorded at baseline and at 12 months. Morphological analyses included central macular thickness (CMT), macular volume (MV), intraretinal or subretinal fluid (IRF/SRF), pigment epithelium detachment (PED), integrity of external limiting membrane (ELM) and ellipsoid zone (EZ). Statistical significance was defined as (p<0.05).
Regarding functional outcomes, after a mean of 7.89 ± 1.22 injections and, BCVA significantly improved from 0.60 ± 0.27 LogMAR to 0.40 ± 0.34 LogMAR. Although the poorest initial BCVA was observed in the type 2 neovascular membranes (0.72 ± 0.29 LogMAR) the gain in BCVA did not vary among the four study subgroups (p>0.05). Analysis of the morphological features showed a reduction in exudative signs (CMT, MV, SRF, IRF and PEDs height) in all subgroups. Nevertheless ELM and EZ integrity was highest in the RAP subtype (p<0.05) and more disruption is detected in the mixed-type lesions (p<0.05); a restoration of both layers is observed in all subtypes of neovascular membranes.
Our findings indicate that although morphological differences are present among different neovascular membranes, aflibercept is an effective treatment for all exudative-AMD subtypes. Quantitative analysis of retinal microstructural changes in each subtype of neovascular-AMD improve our understanding of classic, occult, mixed, and RAP neovascular lesions and their response to treatment