First Author: A.Kovacs HUNGARY
Co Author(s): T. Kiss F. Rarosi R. Degi A. Facsko
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To analyze the putative differences in the prevalence of outer retinal tubulation (ORT) in neovascular age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (anti-VEGF) agents, either aflibercept or ranibizumab. Our further aim was to examine the changes in the frequency of injections of ranibizumab before and after ORT appearance. Furthermore we investigated the presence of subretinal hyperreflective material (SHRM) and its connection with ORT development.
Heidelberg Spectralis optical coherence tomography scans (pattern size 5.7 x 5.7 mm, 20° x 20°, 25 B-scans, distance between B-scans: 236 um, 'follow-up' mode) of wet age-related macular degeneration patients treated with anti-VEGF intravitreal injections.
236 eyes were followed (184 eyes treated with ranibizumab in pro re nata fashion, 52 eyes with aflibercept in bimonthly fashion after treatment initiation) from minimum 6 months to maximum 24 months. Spectral-domain optical coherence tomography images were analyzed. The first appearance of ORT was documented, and fixed time point evaluations were also made every six months to determine the presence of ORT. The number of injections, the presence or absence of SHRM at treatment initiation and the visual acuity was noted.
The survival analysis with Cox proportional hazard model showed no significant difference (p=0.532, the hazard ratio was 0.865) between the ranibizumab and aflibercept treated eyes on the basis of ORT development. In the pro re nata treated ranibizumab group the injection number showed significant decrease after ORT development ( p=0.004. Mann-Whitney-U). When subretinal hyperreflective material was present at treatment initiation the chance of developing ORT was 2.75, and 11.136 higher, than without SHRM in the ranibizumab and aflibercept group respectively.
The chosen anti-VEGF drug did not affect the development of ORT, but in time the prevalence of it continuosly increased. After the appearance of ORT the team of the medical retina can expect a decrease in retreatments, when treated with pro re nata ranibizumab regimen. The presence of SHRM as a biomarker at treatment initiation displayed a statistically significant correlation to the development of ORT in both ranibizumab and aflibercept treated patients.