Anatomical Characteristics of End-stage Exudative Age-related Macular Degeneration Refractory to Intravitreal Anti-vascular Endothelial Growth Factor Injection.
10.3341/jkos.2017.58.10.1145
- Author:
Jun Gi HONG
1
;
Young Wook CHO
;
Ji Hye JANG
Author Information
1. Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea. mjmom99@naver.com
- Publication Type:Original Article
- Keywords:
Disciform retinal scar;
End-stage age-related macular degeneration;
Fibrovascular pigment epithelial detachment
- MeSH:
Cicatrix;
Endothelial Growth Factors*;
Follow-Up Studies;
Hemorrhage;
Humans;
Macular Degeneration*;
Retinal Hemorrhage;
Retinal Pigment Epithelium;
Retinaldehyde;
Retrospective Studies;
Subretinal Fluid;
Tears;
Tomography, Optical Coherence;
Visual Acuity
- From:Journal of the Korean Ophthalmological Society
2017;58(10):1145-1154
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To analyze the anatomical characteristics on spectral-domain optical coherence tomography (SD-OCT) of patients who are legally blind (less than 20/1,000) due to end-stage exudative age-related macular degeneration (AMD) that does not require intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. METHODS: After anti-VEGF injections (active group), 120 eyes of 103 exudative AMD patients experienced visual acuity improved by at least 2 lines or improvement on SD-OCT. In addition, 55 eyes of 54 end-stage exudative AMD patients who did not respond to treatment or who were legally blind due to foveal scar at the first visit (end-stage group) were evaluated retrospectively. Changes in retinal structures of the 2 groups were analyzed by SD-OCT at the last visit. RESULTS: The mean age of the end-stage group was about 5 years older than the active group. During the follow-up period, subretinal hemorrhage, intraretinal hemorrhage and retinal pigment epithelium tear occurred more frequently in the end-stage group than in the active group (p < 0.05). Intra-retinal fluids and subretinal fluids were more frequently administered in the active group than in the end-stage group, and thick subretinal hyper-reflective materials (SRHRM), fibrovascular pigment epithelial detachment (PED) and extensive inner segment/outer segment (IS/OS) line disruption were observed in all eyes of the end-stage group. The size and thickness of PED, foveal thickness and SRHRM thickness were significantly larger in the end-stage group than in the active group (p < 0.05). Disciform retinal scars were eventually formed in most of the end-stage group. CONCLUSIONS: In end-stage exudative AMD, the presence of retinal hemorrhage and retinal pigment epithelium tear during follow-up, or the findings of thick SRHRM, fibrovascular PED, and extensive IS/OS line disruption on SD-OCT suggest weak expected effect of intravitreal anti-VEGF injection, which can act as a reference for determining the timing of treatment termination.
