title: Progression of retinal pigment epithelial atrophy in antiangiogenic therapy of neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To monitor retinal pigment epithelial (RPE) atrophy progression during antiangiogenic therapy of neovascular age-related macular degeneration (AMD) over 2 years using polarization-sensitive optical coherence tomography (OCT).
  
  
  METHODS
  Prospective interventional case series.
  
  
  METHODS
  setting: Clinical practice.
  
  
  METHODS
  Thirty patients (31 eyes) with treatment-naïve neovascular AMD.
  
  
  METHODS
  Standard intravitreal therapy (0.5 mg ranibizumab) was administered monthly during the first year and pro re nata (PRN; as-needed) during the second year. Spectral-domain (SD) OCT and polarization-sensitive OCT (selectively imaging the RPE) examinations were performed at baseline and at 1, 3, 6, 12, and 24 months using a standardized protocol. RPE-related changes were evaluated using a semi-automated polarization-sensitive OCT segmentation algorithm and correlated with SD OCT and fundus autofluorescence (FAF) findings.
  
  
  METHODS
  RPE response, geographic atrophy (GA) progression.
  
  
  RESULTS
  Atrophic RPE changes included RPE thinning, RPE porosity, focal RPE atrophy, and development of GA. Early RPE loss (ie, RPE porosity, focal atrophy) increased progressively during initial monthly treatment and remained stable during subsequent PRN-based therapy. GA developed in 61% of eyes at month 24. Mean GA area increased from 0.77 mm(2) at 12 months to 1.10 mm(2) (standard deviation = 1.09 mm(2)) at 24 months. Reactive accumulation of RPE-related material at the lesion borders increased until month 3 and subsequently decreased.
  
  
  CONCLUSIONS
  Progressive RPE atrophy and GA developed in the majority of eyes. RPE migration signifies certain RPE plasticity. Polarization-sensitive OCT specifically images RPE-related changes in neovascular AMD, contrary to conventional imaging methods. Polarization-sensitive OCT allows for precisely monitoring the sequence of RPE-related morphologic changes.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Austria, Vienna, Austria.
authors.forename: Christopher
authors.initials: C
authors.lastname: Schütze
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Austria, Vienna, Austria.
authors.forename: Manuela
authors.initials: M
authors.lastname: Wedl
authors.affiliation: Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria, Vienna, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Baumann
authors.affiliation: Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Pircher
authors.affiliation: Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria, Vienna, Austria.
authors.forename: Christoph K
authors.initials: CK
authors.lastname: Hitzenberger
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Austria, Vienna, Austria. Electronic address: ursula.schmidt-erfurth@meduniwien.ac.at.
authors.forename: Ursula
authors.initials: U
authors.lastname: Schmidt-Erfurth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001284:Atrophy; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D057092:Geographic Atrophy / Q000175:diagnosis*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D011446:Prospective Studies; D000069579:Ranibizumab; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab