Electrophysiological Assessment of Optic Nerve and Retinal Functions Following Intravitreal Injection of Bevacizumab (Avastin)

Pääkkönen

2015

Acta Ophthalmologica

ABSTRACT.Purpose: In response to anti-VEGF treatment for wet AMD retinal anatomy and visual acuity is often remedied. In our previous study, we showed that visual evoked potentials (VEP) improve following successful anti-VEGF treatment. The aim of this study was to investigate, how visual acuity and retinal thickness changes are reflected in VEP parameters. Moreover, we wanted to assess the feasibility of VEP as a novel monitoring tool for wet AMD patients. Methods: A total of 16 patients and six control subjects were enrolled in this study. Patients received three bevacizumab intravitreal injections. At the beginning of the study and four to 6 weeks after the last injection, the bestcorrected visual acuity (BCVA) test, full biomicroscope examination, OCT analysis and VEP were performed. Results: In treated eyes, logMAR visual acuity improved on average 0.18 AE 0.32 units, OCT retinal thickness decreased 170 AE 200 micrometres and VEP amplitude increased 1.0 AE 1.4 microvolts. All changes were significant at p < 0.05. There was a significant correlation between the relative changes of VEP amplitude and retinal thickness r = À0.630 (p < 0.05), and between visual acuity (logMAR) and retinal thickness r = 0.576 (p < 0.05). Conclusion: We showed that both the increase in VEP amplitude and the improvement in visual acuity are associated with the decrease in retinal thickness in treated wet AMD patients. The results do not indicate additional usefulness of VEP in the diagnosis or monitoring of wet AMD.

Section: Introductionmentioning

confidence: 87%

“…; Sabeti et al. ), but there are only few previous studies where patients are treated for wet AMD and the possible modulation of their VEP is followed (Macky & Mahgoub ). In our previous study, we have shown that beneficial anti‐VEGF injections of wet AMD patients improve the VEP markers (Vottonen et al.…”

Section: Introductionmentioning

confidence: 99%

Best‐corrected visual acuity and retinal thickness are associated with improved cortical visual processing in treated wet AMD patients

Pääkkönen

2015

Acta Ophthalmologica

“…However, the positive and/or negative effects on face processing of the now routine injection treatments have been largely overlooked. There are only 2 groups that have assessed visual evoked potentials (VEP) of wet AMD patients after anti-VEGF injections; reports including 2 of ours, with the key finding of increase in VEP amplitude 28–30. The electrophysiological parameters of face detection in this context have not been reported earlier.…”

Section: Discussionmentioning

confidence: 84%

“…The effects of AMD and its current treatment in any specific cortical visual processes have been only occasionally studied 28–30. Individual patient investigations using functional MRI analysis have examined the reorganization in the visual cortex caused by AMD 31,32.…”

Section: Discussionmentioning

confidence: 99%

Visual processing in patients with age-related macular degeneration performing a face detection test

Pääkkönen

2017

OPTH

PurposePeople with age-related macular degeneration (AMD) have difficulties in familiar face recognition and facial expression discrimination. Our aim was to evaluate the visual processing of faces in AMD patients and whether this would be improved by anti-vascular endothelial growth factor therapy. This was a prospective interventional cohort study.PatientsTwelve patients with monocular wet AMD and 6 control subjects were recruited. Face detection processes were studied using cortical event-related potentials (ERPs). Patients received 3 bevacizumab intravitreal injections to the single affected eye. At baseline and 4–6 weeks after the last injection, clinical presentation and ERPs of the face task were evaluated. Face pictures were shown as targets (16.7%) among standard pictures of pixelated faces in an oddball-type paradigm.ResultsFace pictures elicited well-defined electrical components in occipital and parieto-occipital cortical areas at baseline and after treatment. The face-specific N170 component was evident in all subjects with longer peak latency in patients than in controls (170±13 vs 155±14, P=0.032). Unexpectedly, an early component reflecting unintentional prediction of perceiving a face, that is, deviance-related negativity, was present in patients and controls. Visual acuity of the affected eye seemed improved in patients from logarithm of the minimum angle of resolution 0.71 (±0.33) to 0.52 (±0.39) by 119 (±23) days without accompanying significant change in face-specific ERPs.ConclusionsMonocular wet AMD distinctly influenced face-specific brain electrophysiological components. However, the anti-vascular endothelial growth factor treatment did not improve the binocular face detection ability. The EudraCT number of this study is 2012-000765-20.

“…Since no VEP changes toward the same direction were observed in the nontreated eye, the finding supports the concept that improved peripheral input plays a significant role in the neural plasticity of the visual cortex. In order to confirm these findings, larger population studies are required, and functional technological analyses are needed 11,12…”

Section: Discussionmentioning

confidence: 99%

Changes in neurophysiologic markers of visual processing following beneficial anti-VEGF treatment in macular degeneration

Pääkkönen²,

2013

OPTH

PurposeAntivascular endothelial growth factor (VEGF) agents have been shown to improve visual acuity and prevent vision loss in exudative age-related macular degeneration. As the vision improves relatively quickly in response to intravitreal injections, we wanted to know whether this improvement is reflected in electrophysiological markers of visual cortical processing.Patients and methodsOur interventional case series included six elderly patients who underwent injection treatment to the affected eye. Their visual acuity, tomographic images of retinal thickness, and visual evoked potentials (VEP) were assessed before treatment and six weeks after the last injection.ResultsAll patients showed improved visual acuity and reduced retinal fluid after the treatment. All but one patient showed increased VEP P100 component amplitudes and/or shortened latencies in the treated eye. These VEP changes were consistent with improved vision while the untreated eyes showed no changes.ConclusionsOur results indicate that antivascular endothelial growth factor injections improved visual function of the treated eyes both in the level of the retina and in the level of visual cortical processing.