Abstract
BackgroundOuter retinal tubulations (ORTs) are branching tubular structures located in the outer nuclear layer of the retina. The goal of this study is to determine the prevalence of ORTs observed in eyes with choroidal neovascularization (CNV) undergoing treatment with anti-angiogenic intravitreous injection (IVI) with anti-VEGF (vascular endothelial growth factor) at the Ophthalmology Department of a tertiary hospital in São Paulo, Brazil.MethodsThis is a descriptive study based on medical charts and Spectral-domain Optical Coherence Tomography (Sd-OCT) scans of 142 patients (158 eyes) treated between 2012 and 2014 with IVI of anti-VEGF for CNV. The patients’ data was analysed according to age, gender, pathology, presence of ORTs, and best corrected visual acuity (BCVA). Patients with and without ORTs were compared according to the last BCVA obtained using Chi square corrected by the Yates factor.ResultsORTs were found in a total of 40 out of 158 eyes (25.31 %) with CNV; in 33 out of 119 eyes (27.7 %) with neovascular age-related macular disease (AMD); in 5 out of 8 eyes (62.5 %) with neovascular angioid streaks; and in 2 out of 12 eyes (16.67 %) with myopic neovascular membranes. Most patients with ORTs had BCVA worse than 20/200, significantly worse BCVA than patients without ORTs.ConclusionsRecent studies have considered that the presence of ORTs is indicative of a photoreceptor degeneration process and may represent a final stage of multiple retinal degenerative pathologies. The prevalence of ORTs in eyes with CNV has not been well described, especially when considering the Brazilian population treated in a public health care system. In our study, ORTs were observed in only three different pathologies: neovascular AMD, neovascular angioid streaks and myopic neovascular membranes. The correct recognition of ORTs is fundamental for its differentiation from intraretinal cysts, for the latter is related to the activity of neovascular diseases, and usually guides anti-angiogenic therapy. We conclude that ORTs have a high prevalence in the population studied, and their correct identification presents relevant therapeutic implications.
Highlights
Outer retinal tubulations (ORTs) are branching tubular structures located in the outer nuclear layer of the retina
ORTs were present in only three different pathologies with choroidal neovascularization (CNV): 33 out of 119 eyes (27.7 %) with neovascular age-related macular degeneration (AMD); 5 out of 8 eyes (62.5 %) with neovascular angioid streaks; and 2 out of 12 eyes (16.67 %) with myopic CNV
Other conditions subjected to intravitreous injection (IVI) of anti-vascular endothelial growth factor (VEGF) for CNV did not demonstrate ORTs. (Table 1)
Summary
Outer retinal tubulations (ORTs) are branching tubular structures located in the outer nuclear layer of the retina. The ORTs were initially observed in eyes with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). For CNV related to AMD, the improvement of visual acuity achieved with monthly intravitreal anti-angiogenic treatment for 24 consecutive months led to the approval of this type of treatment by the FDA [11, 12]. Later, studies such as PRONTO [13] and CATT [10] showed that similar visual acuity could be obtained with fewer intravitreal injections, guided by disease activity parameters such as intraretinal or subretinal fluid detected on OCT
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