Characterization of Neovascular Age-Related Macular Degeneration Patients with Outer Retinal Tubulations

Abstract

Purpose: To characterize the neovascular lesions of patients with age-related macular degeneration (AMD) and outer retinal tubulations (ORTs). Methods: A retrospective study of 377 eyes with exudative AMD, submitted to intravitreal anti-angiogenic treatment. Patients were divided into 2 groups according to the presence or absence of ORTs on spectral-domain optical coherence tomography (SD-OCT; group 1 - with ORTs; group 2 - without ORTs). Age, best corrected visual acuity (BCVA), fluorescein angiography characteristics, presence of subretinal fibrosis and subfoveal photoreceptor integrity on SD-OCT were analyzed. Results: Although both groups had a BCVA gain during the follow-up period, initial and final BCVA were lower in group 1 (p = 0.020 and p = 0.042, respectively). There was no statistically significant difference in the BCVA variation between the 2 groups (p = 0.907). Regarding the initial angiographic lesion type, there was a statistically significant difference between the 2 groups (p = 0.008): group 1 had more lesions with a classic component and group 2 had more occult lesions with no classic component. There was a statistically significant difference concerning the loss of subfoveal photoreceptor integrity (p = 0.0007). Conclusions: Even though AMD patients with ORTs were associated with poor visual outcomes, we reported BCVA improvement. AMD patients with a classical component in their lesions are prone to develop ORTs.

Outer retinal tubulations response to anti-VEGF treatment

“…Previously published studies have reported that ORTs are stable and do not represent signs of CNV activity 1 6. However, we report in this study several changes in ORTs with closed configuration, as described by Schaal et al ,11 that may show response to anti-VEGF treatment.…”

“…A study by Faria-Correia et al 6 published in 2012 found that patients with ORTs had mostly type 2 (classic) CNV, supporting the hypothesis that CNV lesions located above the RPE are more prone to induce ORT formation. In our study, we went further and investigated the association between types of fluid and ORT formation, and found that the majority of eyes with ORTs (48.5%) had IRF, followed by combined SRF and IRF (42.4%), and by SRF only (9.1%).…”

“…We note that contradictory data about final visual acuity in ORT eyes have been reported. Faria-Correia et al 6 reported visual improvement during follow-up in the majority of their patients (mean improvement of 3.17 ETDRS letters), while Zweifel et al 1 noted that temporary collapse of ORTs structures was not associated with visual improvement.…”

Outer Retinal Tubulation in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

“…These results are consistent with those described in a recent study, in which ORTs were significantly associated with worse visual acuity before and after the intravitreal anti-VEGF treatment. 10 Previously, we have shown that “IRF”, which included eyes with ORTs, was an independent predictor of poor visual acuity at all time points evaluated through one year. 11 In the present report, we have extended, and further clarified this observation.…”

Prevalence of outer retinal tubulation in eyes with choroidal neovascularization

“…Recent studies have considered that the presence of ORTs is indicative of a photoreceptor degeneration process and may represent the final stage of multiple advanced retinal diseases, such as: neovascular AMD, polypoidal choroidal vasculopathy (and other causes of CNV); retinal or choroidal dystrophies (gyrate atrophy, choroideremia, cone dystrophy, Bietti crystalline dystrophy, Stargardt disease, pattern dystrophy); central serous choroidopathy and acute zonal occult outer retinopathy [1–9, 17, 18]. 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.…”