title: Restoration of Outer Retinal Layers After Aflibercept Therapy in Exudative AMD: Prognostic Value.
abstract: OBJECTIVE
  To evaluate the outer retinal layer (ellipsoid zone [EZ] and external limiting membrane [ELM]) changes following intravitreal aflibercept injections in eyes with treatment-naïve exudative age-related macular degeneration (eAMD) and to correlate these changes with fluid response and visual improvement.
  
  
  METHODS
  A retrospective case series of 50 treatment-naïve eAMD eyes followed-up for 18 months. All patients underwent regular comprehensive ophthalmic examinations. The presence of EZ disruption, ELM disruption, EZ swelling, subretinal hyper-reflective exudation (SHE), central macular thickness (CMT), cystoid spaces, subretinal fluid, and pigmented epithelium detachment were evaluated by two different retinal specialists at baseline and final visits, and correlated with best corrected visual acuity (BCVA) improvement.
  
  
  RESULTS
  At 18 months, BCVA, EZ disruption, ELM disruption, EZ swelling and SHE improved significantly (P = 0.001) at 18 months. Improvement of BCVA showed a statistically significant correlation with ELM restoration (P = 0.018), but not with EZ restoration (P = 0.581). Swelling of the EZ decreased from 72% of the cases at baseline to 30% in 18 months while SHE decreased from 52% to 6% in 18 months (P = 0.001). We observed a statistically significant (P = 0.001) reduction between the baseline and final value of CMT.
  
  
  CONCLUSIONS
  Aflibercept is safe and effective in treating exudative AMD with the restoration of the outer retinal layers. Restoration of the EZ is not statistically correlated with the final BCVA, even though persistent EZ changes could be associated with irreversible decrease in vision. On the contrary, the final status of the ELM is directly correlated with final BCVA. Also, baseline changes in outer retinal layers, especially the ELM, appear to predict photoreceptor restoration and final BCVA, and must be comprehensively analyzed to enable and determine a future prognosis.
authors.affiliation: Department of Ophthalmology Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France 2Centre de l'Odéon, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Coscas
authors.affiliation: Department of Ophthalmology Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France 2Centre de l'Odéon, Paris, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Coscas
authors.affiliation: Department of Ophthalmology Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France 3Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia.
authors.forename: Marco
authors.initials: M
authors.lastname: Lupidi
authors.affiliation: Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon.
authors.forename: Ali
authors.initials: A
authors.lastname: Dirani
authors.affiliation: Department of Ophthalmology Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France.
authors.forename: Mayer
authors.initials: M
authors.lastname: Srour
authors.affiliation: Department of Ophthalmology Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France.
authors.forename: Oudy
authors.initials: O
authors.lastname: Semoun
authors.affiliation: Centre de l'Odéon, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Français
authors.affiliation: Department of Ophthalmology Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Souied
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D001485:Basement Membrane / Q000473:pathology; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor