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Inner retinal layer change in glaucoma patients receiving anti-VEGF for neovascular age related macular degeneration

  • Medical Ophthalmology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

The purpose was to evaluate the effects of long-term anti-VEGF treatment on the retinal nerve fiber layer (RNFL) and retinal ganglion cell layer (RGCL) thickness for patients with neovascular AMD and glaucoma.

Methods

Medical records of respective patients who had received more than 15 anti-VEGF injections were reviewed. Initial and latest SD-OCT macular scans were segmented and changes of the RNFL and RGCL thickness at the four outer ETDRS quadrants were evaluated. Secondary outcome measures included changes of visual field parameters seen in automated perimetry.

Results

Sixteen patients were included (mean age 78 ± 6 years). The mean total number of anti-VEGF injections was 39 ± 16. The mean treatment duration was 6.1 ± 2.1 years. The mean IOP decreased from 18 ± 5 mmHg at baseline to 15 ± 5 mmHg at the last visit (p = 0.026). The mean RNFL thickness volume of the outer ETDRS quadrants (0.98 ± 0.18 mm3 to 0.97 ± 0.18 mm3 p = 0.61) and its average thickness (37.9 ± 7.3 μm to 37.2 ± 7.4 μm, p = 0.6) did not significantly change. However, the average RGCL thickness decreased significantly from 0.86 ± 0.12 mm3 to 0.79 ± 0.11 mm3 (p = 0.01), and from 27.7 ± 4.2 to 25.9 ± 3.7 μm (p = 0.01). Number of injections correlated with the RGCL change (r2 = 0.36, p = 0.01). The mean sensitivity, mean defect and absolute scotomata did not significantly change with p-values of 0.28, 0.21 and 0.07, respectively.

Conclusion

Patients under long term treatment with anti-VEGF and concurrent glaucoma show significant decrease in macular RGLC volume. However, this decrease is comparable to reported RGCL decrease in patients under anti-VEGF treatment without underlying glaucoma and suggests that glaucoma patients may not be at a higher risk for losing macular RNFL and RGCL, at least if adequate control of intraocular pressure is maintained.

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Authors and Affiliations

  1. Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland

    Rafidah Saleh, Aashraya Karpe, Martin S. Zinkernagel & Marion R. Munk

  2. Department of Clinical Research, University Hospital Bern, Bern, Switzerland

    Martin S. Zinkernagel

  3. Bern Photographic Reading Center, Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland

    Martin S. Zinkernagel & Marion R. Munk

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  1. Rafidah Saleh
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Correspondence to Marion R. Munk.

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Funding

No funding was received for this research. Martin S Zinkernagel is a stock holder and a consultant for Novartis and a consultant for Bayer. Marion R Munk is a consultant for Novartis and Bayer and received travel grants from Bayer. The remaining authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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The authors have no conflict of interest to report.

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Supplemental Table 1

(DOCX 16 kb)

Supplemental Fig. 1

Scatter blot of average retinal nerve fiber layer (RNFL) thickness of the ETDRS outer rings in patients with glaucoma and neovascular age-related macular degeneration under long-term anti-VEGF treatment at baseline (BL) and last follow-up visit (FU). No significant changes were noted over time. (GIF 13 kb)

High resolution image (TIF 306 kb)

Supplemental Fig. 2

Scatter blot of average the retinal ganglion cell layer (RGCL) thickness of the ETDRS outer rings in patients with glaucoma and neovascular age-related macular degeneration under long-term anti-VEGF treatment at baseline (BL) and last follow-up visit (FU).at baseline (BL) and last follow-up visit (FU). Significant decrease of RGCL thickness was noted over time. (GIF 14 kb)

High resolution image (TIF 312 kb)

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Saleh, R., Karpe, A., Zinkernagel, M.S. et al. Inner retinal layer change in glaucoma patients receiving anti-VEGF for neovascular age related macular degeneration. Graefes Arch Clin Exp Ophthalmol 255, 817–824 (2017). https://doi.org/10.1007/s00417-017-3590-4

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  • DOI: https://doi.org/10.1007/s00417-017-3590-4

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