Abstract

SA.16.04

Retinal morphology following anti-VEGF-treatment: A detailed analysis of discrete intraretinal changes during a loading dose regimen with ranibizumab therapy

Teresa Schneiderbauer, Christian Ahlers, Isabelle Golbaz, Christopher Schütze, Stefan Sacu, Geraldine Stock, Ursula Schmidt-Erfurth
Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Wien, Österreich

Objective
High-definition raster scanning optical coherence tomography (SD-OCT) allows a better assessment of retinal layers and a more detailed detection of morphologic alterations. The aim of this study was to identify such alterations in patients with neovascular age-related macular degeneration (nAMD) under anti-VEGF-therapy and to evaluate if they show characteristic properties over the time course of a loading regimen with ranibizumab.
Methods
This study included 33 consecutive patients suffering from untreated nAMD. Imaging was performed using a SD-OCT (Cirrus, Carl Zeiss Meditec) with an axial resolution of 6 µm and a scan velocity of up to 25 kA-scans/s at baseline, month 1 and 3 after the first anti-VEGF-injection. The scanned area measured 6x6 mm and had a depth of 2 mm. Characteristic changes in the retinal microstructure were documented and analyzed following a standardised expert examiner reading procedure.
Results
Known and obvious morphological changes like intra- or subretinal edema showed a clear improvement until the third month following the initial ranibizumab-injection. This improvement was accompanied by improvement of discrete intraretinal alterations and restoration of intraretinal-layer structure. Destructions of the neurosensory retina and diffuse hyperreflectivities previously present in the outer plexiform layer (OPL) were also significantly reduced under treatment. Some other layer specific intraretinal changes identified in this study like hyperreflective spots within outer retinal layers and hyperreflective deposits located underneath the photoreceptor layer remained stable in the study.
Conclusions
SD-OCT was able to detect additional information on specific morphologic alterations within the retina. These changes showed a defined regression under consequent treatment indicating their potential value to monitor ant steer anti-angiogenic strategies. While showing significant remission at month 1 in response to the initial anti-VEGF injection, some discrete destructions of the photoreceptor layers persisted up to month 3 indicating a considerable but incomplete reversibility of retinal damage after a phase of acute nAMD activity.

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