title: Recovery of photoreceptor outer segments after anti-VEGF therapy for age-related macular degeneration.
abstract: OBJECTIVE
  To evaluate whether the status of the external limiting membrane (ELM) or inner segment/outer segment junction (IS/OS) improves after intravitreal injection of ranibizumab for age-related macular degeneration (AMD). We also evaluated whether the pre-operative values of these parameters are associated with the visual prognosis.
  
  
  METHODS
  This was a hospital-based, cross-sectional study. Seventy-six eyes of 76 treatment-naive AMD patients who received three monthly intravitreal injections of ranibizumab followed for more than 6 months with additional as-needed injections were investigated. Spectral domain OCT was used to evaluate the length of ELM, IS/OS, and foveal thickness pre- and post-operatively. Changes of ELM and IS/OS length were evaluated postoperatively. Correlation coefficients between pre-operative parameters and post-operative visual acuity were also analyzed.
  
  
  RESULTS
  Significant changes were noted in mean logMAR (0.66 to 0.53), foveal thickness (231.1 to 151.1 μm), and IS/OS length (514.9 to 832.3 μm) after the treatment. ELM length did not improve significantly (1,312.4 to 1,376.7 μm). Restoration of IS/OS occurred where ELM is retained. Although pre-operative ELM length, IS/OS length, and foveal thickness showed correlation with post-operative logMAR (R = -0.51, -0.39, and 0.46, respectively), the most powerful predictive factor for visual prognosis was pre-operative logMAR (R = 0.77, p < 0.001).
  
  
  CONCLUSIONS
  IS/OS status improves in response to anti-VEGF therapy but ELM seems to have less plasticity. The status of IS/OS and ELM can be used as prognostic factors but the predictive power is inferior to that of baseline visual acuity.
authors.affiliation: Department of Ophthalmology, Kobe City Medical Center General Hospital, 4-6 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0046, Japan. aquio@kuhp.kyoto-u.ac.jp
authors.forename: Akio
authors.initials: A
authors.lastname: Oishi
authors.forename: Masataka
authors.initials: M
authors.lastname: Shimozono
authors.forename: Michiko
authors.initials: M
authors.lastname: Mandai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hata
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishida
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kurimoto
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D001485:Basement Membrane; D004396:Coloring Agents; D003430:Cross-Sectional Studies; D019773:Epiretinal Membrane / Q000503:physiopathology; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D015588:Observer Variation; D000069579:Ranibizumab; D020127:Recovery of Function / Q000502:physiology; D055211:Retinal Photoreceptor Cell Inner Segment / Q000502:physiology*; D055214:Retinal Photoreceptor Cell Outer Segment / Q000502:physiology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D004396:Coloring Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D007208:Indocyanine Green; D000069579:Ranibizumab