Abstract
BackgroundWe aimed to analyze the 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.MethodsTwo hundred thirty six eyes of 230 patients were included in the study (184 eyes treated with ranibizumab by pro re nata regimen (PRN), 52 eyes with aflibercept bimonthly) and followed for 6–24 months. Using optical coherence tomography (OCT), the first appearance of ORT was documented, and fixed time point evaluations were also made every six months to determine the existence of ORT. The number of injections, the presence or absence of subretinal hyperreflective material (SHRM) at treatment initiation and visual acuity were also noted.ResultsThe survival analysis with Cox proportional hazard model showed no significant difference between the ranibizumab and aflibercept groups in relation to the development of ORT (p = 0.79, hazard ratio 0.92). In the PRN treated ranibizumab group the number of injections showed significant decrease after ORT development (p = 0.004). When SHRM was present at treatment initiation the chance of developing ORT was 2.75 and 11.14 times higher in the ranibizumab and aflibercept groups, respectively.ConclusionsThe prevalence of ORT increased over time independently from the chosen anti-VEGF drug. Our results suggest that upon the appearance of ORT a decrease in retreatments can be expected.
Highlights
We aimed to analyze the differences in the prevalence of outer retinal tubulation (ORT) in neovascular age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor agents, either aflibercept or ranibizumab
ORT can be mistaken for intraretinal cysts, or subretinal fluid but with the recognition of its hyperreflective border and special occurrence in the outer nuclear layer these mistakes can be reduced, leading to a reduction in the rate of anti-VEGF overtreatment in exudative AMD [2]
In the ranibizumab group outer retinal tubulation was observed in 17.4% of cases at baseline, in 33.7% of cases at month 6, in 45.3% of cases at month 12, and in 55.3% and in 60.8% of cases at months 18 and 24, respectively
Summary
We aimed to analyze the differences in the prevalence of outer retinal tubulation (ORT) in neovascular age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (antiVEGF) agents, either aflibercept or ranibizumab. Outer retinal tubulation (ORT) is a spectral-domain optical coherence tomography (SD-OCT) biomarker [1], first described by Zweifel et al [2]. They defined ORTs as hyporeflective, branching tubular structures with hyperreflective borders within the outer nuclear layer of the retina [2]. ORT can be mistaken for intraretinal cysts, or subretinal fluid but with the recognition of its hyperreflective border and special occurrence in the outer nuclear layer these mistakes can be reduced, leading to a reduction in the rate of anti-VEGF overtreatment in exudative AMD [2]. The importance of ORT as an OCT biomarker for photoreceptor degeneration is due to its connection with reduced visual acuity [1, 8,9,10]
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