Abstract

Purpose

The primary aim of the study was to investigate the effects of anti-vascular endothelial growth factor (VEGF) injections on the inner retinal layer anatomy of the lesion-free retina in eyes treated for neovascular age-related macular degeneration (nAMD). The secondary aim was to compare the changes of inner retinal layers in the lesion-free region of treated eyes with the same region of the untreated, fellow eyes and, thus, to elucidate any adverse effect of anti-VEGF treatments independently of 1-year aging changes.

Methods

This was a retrospective, longitudinal, case–control study of 50 eyes of 25 patients. Twenty-five eyes with nAMD comprised the study group (16 eyes treated with aflibercept and 9 eyes treated with ranibizumab) and 25 fellow eyes with dry AMD (16 eyes in AREDS 2 and 9 eyes in AREDS 3) comprised the fellow eye group. Spectral-domain optical coherence tomography (SD-OCT) measurements were done at pre-treatment, 1 month after three loading anti-VEGF injections and at the end of 1 year. The retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL) thicknesses and total retinal thickness in the macula were measured. Thicknesses of inner retinal layers which were lesion-free in the outer nasal subfield of ETDRS grid were analysed and the changes in thicknesses during the follow-up period were compared between study and fellow eye groups. Paired t-test for normally distributed variables was applied for analyses of differences for the comparison of the results across the pre-and the post-. A p value of less than 0.05 was considered statistically significant.

Results

The mean number of injections was 5.76 ± 1.26 in the study group in 1 year. The mean decrease in total retinal thickness was significant with 6.08 ± 9.05 µm (p= 0.003) in nAMD group and was insignificant with 0.32 ± 1.03 µm (p> 0.05) in fellow eye group with dry AMD. Most of the retinal thickness decrease was during first three injections in nAMD group. Total retinal thickness and GCL thickness were thinner in the study group at every follow-up examination, but the difference between groups was not statistically significant (p> 0.05). RNFL, GCL, IPL, and INL thicknesses did not demonstrate a statistically significant change in both study and fellow eye groups during 1 year follow-up period (p> 0.05).

Conclusions

Repeated anti-VEGF injections in nAMD appear to have no significant effect on the RNFL, GCL, IPL, and INL thicknesses of the lesion-free retina. Additionally, there was no significant difference in inner retinal layer changes between in eyes treated with anti-VEGF injections for nAMD and fellow eye group during 1-year follow-up.

中文翻译：

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玻璃体内抗血管内皮生长因子注射对无病变视网膜内层的解剖学影响

摘要

目的

该研究的主要目的是研究抗血管内皮生长因子 (VEGF) 注射对接受新生血管性年龄相关性黄斑变性 (nAMD) 治疗的眼睛无损伤视网膜的视网膜内层解剖结构的影响。次要目的是比较治疗眼的无病变区域与未治疗的对侧眼相同区域的视网膜内层变化，从而阐明抗 VEGF 治疗的任何副作用，与 1 年无关老化的变化。

方法

这是一项回顾性、纵向、病例对照研究，涉及 25 名患者的 50 只眼睛。25 只 nAMD 眼构成研究组（16 只眼用阿柏西普治疗，9 只眼用雷珠单抗治疗）和 25 只干性 AMD 对侧眼（AREDS 2 中 16 只眼和 AREDS 3 中 9 只眼）构成对侧眼组。光谱域光学相干断层扫描 (SD-OCT) 测量在治疗前、3 次加载抗 VEGF 注射后 1 个月和 1 年结束时进行。测量了黄斑中的视网膜神经纤维层 (RNFL)、神经节细胞层 (GCL)、内丛状层 (IPL)、内核层 (INL) 厚度和总视网膜厚度。分析ETDRS网格外鼻亚区无病变的视网膜内层厚度，并比较研究组和其他眼组在随访期间的厚度变化。配对正态分布变量的t检验应用于差异分析，以比较前后结果。p值小于 0.05 被认为具有统计学意义。

结果

研究组 1 年内的平均注射次数为 5.76 ± 1.26。nAMD 组视网膜总厚度的平均减少显着为 6.08 ± 9.05 µm ( p = 0.003)，而干性 AMD 对侧眼组的视网膜总厚度平均减少为 0.32 ± 1.03 µm ( p > 0.05)。大部分视网膜厚度减少是在 nAMD 组的前 3 次注射期间。每次随访时研究组视网膜总厚度和GCL厚度均较薄，但组间差异无统计学意义（p > 0.05）。RNFL、GCL、IPL 和 INL 厚度在 1 年随访期间在研究组和对侧眼组中均未显示出统计学上显着的变化（p > 0.05）。

结论

在 nAMD 中反复注射抗 VEGF 似乎对无病变视网膜的 RNFL、GCL、IPL 和 INL 厚度没有显着影响。此外，在 1 年的随访期间，接受抗 VEGF 注射治疗 nAMD 的眼睛和对侧眼组的视网膜内层变化没有显着差异。