Dose-Response Relationship between Intravitreal Injections and Retinal Nerve Fiber Layer Thinning in Age-Related Macular Degeneration

Wang, Liang; Swaminathan, Swarup S.; Yang, Jin; Barikian, Anita; Shi, Yingying; Shen, Mengxi; Jiang, Xiaoshuang; Feuer, William J.; Gregori, Giovanni; Rosenfeld, Philip J.

doi:10.1016/j.oret.2020.10.004

Cited by 12 publications

(12 citation statements)

References 41 publications

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“…However, Wang L et al documented that the relationship between RNFL thinning and the number of injections becomes apparent after 30 injections. 21 As they rightly noted, the effects of such treatment on the nerve fiber layer in most of the previously cited works were observed in research groups consisting of patients that received less than thirty injections. 21 In our study, the maximum number of injections received by the patient was 31.…”

Section: Discussionmentioning

confidence: 96%

“… 21 As they rightly noted, the effects of such treatment on the nerve fiber layer in most of the previously cited works were observed in research groups consisting of patients that received less than thirty injections. 21 In our study, the maximum number of injections received by the patient was 31. However, we did not find RNFL thinning in the group with wAMD versus dAMD.…”

Section: Discussionmentioning

confidence: 96%

“…In the literature, assumed nerve injury is examined mainly through morphological evaluation using optical coherence tomography imaging. 5,[20][21][22][23][24][25][26] According to our knowledge, this work is the first to assess the functioning of the nerve and retinal ganglion cells (which are histologically continuous with the nerve fibers), using electrophysiological PVEP and PERG examinations, in a population of patients undergoing chronic wAMD therapy with intravitreal anti-VEGFs.…”

Section: Introductionmentioning

confidence: 99%

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Morphological and Functional Assessment of the Optic Nerve Head and Retinal Ganglion Cells in Dry vs Chronically Treated Wet Age-Related Macular Degeneration

Wichrowska¹,

Wichrowski²,

Kocięcki³

2022

OPTH

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Purpose The aim of the study comprised the anatomical and functional assessment of the optic nerves and macular ganglion cells in the population of patients with unilateral wet age-related macular degeneration (wAMD) and comparison of its results to those obtained from the fellow eye with non-advanced dry age-related macular degeneration (dAMD). Furthermore, we aimed to determine if the number of administered injections contributed to the potential differences between the examined eyes. Methods The study was based on 104 eyes of 52 patients in a cross-sectional study. The eyes with chronically treated wAMD were the main subject of the study, while fellow eyes affected with non-advanced dAMD served as the control group. Primary morphological outcomes comprised differences in peripapillary retinal nerve fiber layer (RNFL) and GCC layers between the studied groups (treated and control). In turn, primary functional outcomes included differences in implicit times and amplitudes of the P100 wave of pattern visual evoked potentials (PVEP) and N95 wave of pattern electroretinogram (PERG) between treated and control groups. Results We did not find any differences in total RNFL thickness between wAMD and dAMD groups. The number of injections only affected the RNFL in the nasal quadrant of the optic disc (p = 0.023). We did not find any differences regarding GCL thickness in both groups. In the study group, a longer implicit time of the P100 of PVEP (p = 0.014) and a shorter amplitude of the P50-N95 wave of PERG (p = 0.005) were detected. The total number of injections had no significant effect on these two values. Conclusion We detected worse functional parameters of the optic nerve and retinal ganglion cells in eyes with wAMD, with lack of significant differences in anatomical (RNFL, GCL) parameters compared to the control group. However, the number of injections did not contribute to the differences found.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Morphological and Functional Assessment of the Optic Nerve Head and Retinal Ganglion Cells in Dry vs Chronically Treated Wet Age-Related Macular Degeneration

Wichrowska¹,

Wichrowski²,

Kocięcki³

2022

OPTH

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“…29 A dose-response relationship between RNFL thinning and the number of anti-VEGF injections for nAMD has also been shown, thereby suggesting a cumulative effect. 7 However, other studies have shown conflicting evidence that demonstrates no change in RNFL thickness, even after a follow-up period of 2 years. 10,11…”

Section: Discussionmentioning

confidence: 99%

“…However, recent studies have questioned this dogma and reported that regular intravitreal anti-VEGF injections used to treat the condition might affect the retinal nerve fiber layer (RNFL). 7 In turn, this would affect the patient’s peripheral vision. Martinez-de-la-Casa et al found that eyes treated with ranibizumab for nAMD sustained a statistically significant decrease in RNFL thickness compared with the control group after just 12 months.…”

Section: Introductionmentioning

confidence: 99%

Ganglion Cell Layer Thickness Change in Neovascular Age-Related Macular Degeneration Treated With Anti-VEGF Injections

Mantopoulos

Ray

Sánchez

et al. 2021

Journal of VitreoRetinal Diseases

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Purpose: This work assesses bilateral ganglion cell layer–inner plexiform layer (GCL-IPL) thickness changes in patients with unilateral neovascular age-related macular degeneration (nAMD) treated with antivascular endothelial growth factor (anti-VEGF). Methods: In this single-center, retrospective, cohort study, the medical records of patients with unilateral nAMD treated with anti-VEGF were reviewed. The treated group included eyes with newly diagnosed nAMD that subsequently underwent treatment with intravitreal anti-VEGF injections. The control group was the fellow eye with dry AMD. Eyes receiving at least 10 intravitreal injections were included. Measurement of GCL-IPL thickness was performed at different time points using spectral domain–optical coherence tomography. Results: A total of 216 eyes of 108 patients met the inclusion criteria. The mean age ± SD was 80.1 ± 10.7 years. Eyes in the treated group underwent a mean ± SD of 20.2 ± 7.2 injections in 21.3 ± 6.8 months. At baseline, average mean ± SD of GCL-IPL thickness was 73.71 ± 8.81 µm and 73.84 ± 8.26 µm in the treated and fellow eye, respectively ( P = .795). After 10 injections the average thickness was 65.41 ± 14.08 µm and 68.77 ± 13.24 µm in the treated and fellow eye, respectively ( P = .007). The absolute decrease in thickness was significantly greater in the treated eye than the fellow eye (mean ± SD, 8.31 ± 11.19 µm vs 5.07 ± 10.83 µm, respectively; P = .002). Conclusions: GCL-IPL thickness decreased significantly in the treated group more than in the control group after 10 anti-VEGF injections. The mechanism and clinical significance of this observation warrants further study.

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Rates of RNFL Thinning in Patients with Suspected or Confirmed Glaucoma Receiving Unilateral Intravitreal Injections for Exudative AMD

Swaminathan

Kunkler

Quan

et al. 2021

American Journal of Ophthalmology

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Dose-Response Relationship between Intravitreal Injections and Retinal Nerve Fiber Layer Thinning in Age-Related Macular Degeneration

Cited by 12 publications

References 41 publications

Morphological and Functional Assessment of the Optic Nerve Head and Retinal Ganglion Cells in Dry vs Chronically Treated Wet Age-Related Macular Degeneration

Morphological and Functional Assessment of the Optic Nerve Head and Retinal Ganglion Cells in Dry vs Chronically Treated Wet Age-Related Macular Degeneration

Ganglion Cell Layer Thickness Change in Neovascular Age-Related Macular Degeneration Treated With Anti-VEGF Injections

Rates of RNFL Thinning in Patients with Suspected or Confirmed Glaucoma Receiving Unilateral Intravitreal Injections for Exudative AMD

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