title: Retinal Ganglion Cell Layer Change in Patients Treated With Anti-Vascular Endothelial Growth Factor for Neovascular Age-related Macular Degeneration.
abstract: OBJECTIVE
  To evaluate macular retinal ganglion cell thickness in patients with neovascular age-related macular degeneration (AMD) and intravitreal anti-vascular endothelial growth factor (VEGF) therapy.
  
  
  METHODS
  Retrospective case series with fellow-eye comparison.
  
  
  METHODS
  Patients with continuous unilateral anti-VEGF treatment for subfoveal and juxtafoveal neovascular AMD and a minimum follow-up of 24 months were included. The retinal nerve fiber (RNFL) and retinal ganglion cell layer (RGCL) in the macula were segmented using an ETDRS grid. RNFL and RGCL thickness of the outer ring of the ETDRS grid were quantified at baseline and after repeated anti-VEGF injections, and compared to the patients' untreated fellow eye. Furthermore, best-corrected visual acuity (BCVA), age, and retinal pigment epithelium (RPE) atrophy were recorded and correlated with RNFL and RGCL.
  
  
  RESULTS
  Sixty eight eyes of 34 patients (23 female and 11 male; mean age 76.7 (SD ± 8.2) with a mean number of 31.5 (SD ± 9.8) anti-VEGF injections and a mean follow-up period of 45.3 months (SD ± 10.5) were included. Whereas the RGCL thickness decreased significantly compared to the noninjected fellow eye (P = .01), the decrease of the RNFL was not significant. Visual acuity gain was significantly correlated with RGCL thickness (r = 0.52, P < .05) at follow-up and negatively correlated (r = -0.41, P < .05) with age. Presence of RPE atrophy correlated negatively with the RGCL thickness at follow-up (r = -0.37, P = .03).
  
  
  CONCLUSIONS
  During the course of long-term anti-VEGF therapy there is a significant decrease of the RGCL in patients with neovascular AMD compared to the fellow (untreated) eye.
authors.affiliation: Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Beck
authors.affiliation: Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Bern Photographic Reading Center, Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Marion R
authors.initials: MR
authors.lastname: Munk
authors.affiliation: Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ebneter
authors.affiliation: Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Bern Photographic Reading Center, Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wolf
authors.affiliation: Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Bern Photographic Reading Center, Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: m.zinkernagel@gmail.com.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Zinkernagel
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D001284:Atrophy; D000068258:Bevacizumab / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009412:Nerve Fibers / Q000473:pathology*; D000069579:Ranibizumab / Q000627:therapeutic use; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab