scholarly journals OCT Biomarkers in Neovascular Age-Related Macular Degeneration: A Narrative Review

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Cristian Metrangolo ◽  
Simone Donati ◽  
Marco Mazzola ◽  
Liviana Fontanel ◽  
Walter Messina ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Treatment Response ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Initial Assessment ◽  
Clinical Approach ◽  
Age Related

Age-related macular degeneration (AMD) is the leading cause of legal blindness in elderly people. Neovascular AMD (nAMD) is responsible for the majority of cases of severe visual loss in eyes with AMD. Optical coherence tomography (OCT) is the most widely used technology for the diagnosis and follow-up of nAMD patients, which is widely used to study and guide the clinical approach, as well as to predict and evaluate treatment response. The aim of this review is to describe and analyze various structural OCT-based biomarkers, which have practical value during both initial assessment and treatment follow-up of nAMD patients. While central retinal thickness has been the most common and one of the first OCT identified biomarkers, today, other qualitative and quantitative biomarkers provide novel insight into disease activity and offer superior prognostic value and better guidance for tailored therapeutic management. The key importance of retinal fluid compartmentalization (intraretinal fluid, subretinal fluid, and subretinal pigment epithelium (RPE) fluid) will be discussed firstly. In the second part, the structural alterations of different retinal layers in various stages of the disease (photoreceptors layer integrity, hyperreflective dots, outer retinal tubulations, subretinal hyperreflective material, and retinal pigment epithelial tears) will be analyzed in detail. The last part of the review will focus on how alterations of the vitreoretinal interface (vitreomacular adhesion and traction) and of the choroid (sub-RPE hyperreflective columns, prechoroidal clefts, choroidal caverns, choroidal thickness and choroidal volume, and choroidal vascular index) interact with nAMD progression. OCT technology is evolving very quickly, and new retinal biomarkers are continuously described. This up-to-date review article provides a comprehensive description on how structural OCT-based biomarkers provide a valuable tool to monitor the progression of the disease and the treatment response in nAMD patients. Thus, in this perspective, clinicians will be able to allocate hospital resources in the best possible way and tailor treatment to the individual patient’s needs.

Intraretinal, sub-retinal, and sub-retinal pigmented epithelium fluid in non-exudative age-related macular degeneration: follow-up with OCT imaging

2021 ◽  
pp. 112067212110362
Author(s):  
Anindya Samanta ◽  
Mahima Jhingan ◽  
Supriya Arora ◽  
Sumit Singh ◽  
Davide Tucci ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Exudative Amd ◽  
Age Related ◽  
Intraretinal Fluid ◽  
Long Term Follow Up

Background/objectives: To evaluate the presence and evolution of fluid in non-exudative age-related macular degeneration (AMD) through serial OCT. Subjects/methods: A retrospective analysis of eyes with non-exudative AMD with a minimum of 4 year follow-up was done. Parameters including intraretinal fluid (IRF), subretinal fluid (SRF), and sub-retinal pigment epithelium (RPE) fluid (SRPEF); subfoveal choroidal thickness (SFCT) and type of drusen were evaluated using optical coherence tomography (OCT) scans at baseline and follow up visits. Results: Seventy-two eyes (in 63 patients) were followed up for an average of 5.83 ± 2.17 years. A total of 26/72 (36%) and 29/65 (52%) of the non-exudative eyes had fluid during baseline and the last visit. Seven eyes (10%) out of 72 eyes converted into exudative AMD or neo-vascular AMD (nAMD) during the study period. SRPEF at baseline was most common fluid location for non-exudative eyes that eventually converted to nAMD. Conclusion: Non-exudative fluid including IRF, SRF, and SRPEF is seen in patients with non-exudative AMD with increasing incidence during long term follow-up.

scholarly journals Comparative Safety of Bevacizumab, Ranibizumab, and Aflibercept for Treatment of Neovascular Age-Related Macular Degeneration (AMD): A Systematic Review and Network Meta-Analysis of Direct Comparative Studies

2020 ◽  
Vol 9 (5) ◽  
pp. 1522 ◽  
Author(s):  
Anna A. Plyukhova ◽  
Maria V. Budzinskaya ◽  
Kirill M. Starostin ◽  
Robert Rejdak ◽  
Claudio Bucolo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Meta Analysis ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Macular Atrophy ◽  
Age Related

Background: Since the efficacy of ranibizumab (RBZ), bevacizumab (BVZ) and aflibercept (AFB) is comparable in neovascular age-related macular degeneration (AMD), we conducted a systematic review and meta-analysis to evaluate the long-term safety profiles of these agents, including ocular safety. Methods: Systematic review identifying randomized controlled trials (RCTs) comparing RBZ, BVZ and AFB directly published before March 2019. Serious ocular adverse events (SOAE) of special interest were endophthalmitis, pseudo-endophthalmitis, retinal pigment epithelium tear and newly identified macular atrophy. Results: Thirteen RCTs selected for meta-analysis (4952 patients, 8723 people-years follow-up): 10 compared RBZ vs. BVZ and three RBZ vs. AFB. There were no significant differences in almost all adverse events (systemic and ocular) between BVZ, RBZ and AFB in up to two years’ follow-up. Macular atrophy was reported heterogeneously and not reported as SOAE in most trials. Conclusions: Direct comparison of RBZ, BVZ and AFB safety profiles in the RCT network meta-analytical setting have not revealed a consistent benefit of these three commonly used anti-vascular endothelial growth factor (anti-VEGF) agents in AMD. Network model ranking highlighted potential benefits of RBZ in terms of a systemic safety profile; however, this appears a hypothesis rather than a conclusion. Newly identified macular atrophy is underestimated in RCTs—future real-world data should be focused on SOAE.

scholarly journals Dry Age-Related Macular Degeneration – A New Approach In Optical Coherence Tomography Monitoring And Quantitative Assessment

2014 ◽  
Vol 7 (2) ◽  
pp. 148-154
Author(s):  
Elitsa G. Hristova ◽  
Zornitsa I. Zlatarova
Keyword(s):  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Three Dimensional ◽  
Software Tool ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Dry Amd ◽  
Area And Volume

Summary The purpose of the study was to present the ability of Drusen analysis software tool to measure drusen area and volume in patients with dry age-related macular degeneration (AMD). Eleven patients with confirmed dry AMD aged 59-74 years were scanned with 3D OCT-2000 Topcon 3D Macula scanning protocol by a single operator. All subjects underwent a complete ophthalmologic examination including best corrected visual acuity, indirect biomicroscopy, tonometry, fluorescein angiography and OCT. Drusen analysis was performed on the macula with 6.0 × 6.0 mm volume cube scans and 512×128 pixels scan resolution. The results were presented along with calculated values in two clearly arranged reports. Mean follow-up period was 19 months (6-40). Count, area occupation, volume of the drusen and 3D retinal pigment epithelium (RPE) elevation map were presented in a Macula drusen analysis report. Drusen count and volume in 6 patients were increased at the end of follow-up period. There were 5 patients with regression in drusen count and area and volume of the drusen in 3 of them were higher than on previous examination. Another 2 were with regression not only in drusen count but also in their area and volume. With this software tool the status of RPE can be objectively and automatically examined in detail and can be followed up over time. OCT allows for precise quantitative evaluation and study of microstructural changes in patients with dry AMD and provides three-dimensional information of macular pathology in situ and in real time. This could be useful for determining stages and monitoring the progression of AMD.

Non-neovascular age-related macular degeneration with subretinal fluid

2020 ◽  
pp. bjophthalmol-2020-317326 ◽  
Author(s):  
Assaf Hilely ◽  
Adrian Au ◽  
K Bailey Freund ◽  
Anat Loewenstein ◽  
Eric H Souied ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Retinal Pigment Epithelial ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Pigment Epithelial ◽  
Age Related ◽  
Sd Oct

PurposeTo evaluate the various patterns of subretinal fluid (SRF) in eyes with age-related macular degeneration (AMD) in the absence of macular neovascularisation (MNV) and to assess the long-term outcomes in these eyes.MethodsThis retrospective study included only eyes with non-neovascular AMD and associated SRF. Eyes with evidence of MNV were excluded. Spectral-domain optical coherence tomography (SD-OCT) was obtained at baseline and at follow-up, and qualitative and quantitative SD-OCT analysis of macular drusen including drusenoid pigment epithelial detachment (PED) and associated SRF was performed to determine anatomic outcomes.ResultsForty-five eyes (45 patients) were included in this analysis. Mean duration of follow-up was 49.7±36.7 months. SRF exhibited three different morphologies: crest of fluid over the apex of the drusenoid PED, pocket of fluid at the angle of a large druse or in the crypt of confluent drusen or drape of low-lying fluid over confluent drusen. Twenty-seven (60%) of the 45 eyes with fluid displayed collapse of the associated druse or drusenoid PED and 24 (53%) of the 45 eyes developed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy.ConclusionNon-neovascular AMD with SRF is an important clinical entity to recognise to avoid unnecessary anti-vascular endothelial growth factor therapy. Clinicians should be aware that SRF can be associated with drusen or drusenoid PED in the absence of MNV and may be the result of retinal pigment epithelial (RPE) decompensation and RPE pump failure.

scholarly journals Сlinical analysis of the series of A-VEGF therapy in patients with retinal pigment epithelium tear complicating of wet form age-related macular degeneration

2021 ◽  
pp. 89-94
Author(s):  
E.V. Kozina ◽  
◽  
S.N. Sakhnov ◽  
V.V. Myasnikova ◽  
E.V. Bykova ◽  
...  
Keyword(s):  
Retinal Pigment Epithelium ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Pathological Process ◽  
Age Related Macular Degeneration ◽  
Results Of Treatment ◽  
Age Related ◽  
Wet Amd

Purpose. Analysis A-VEGF therapy for wet form age-related macular degeneration (AMD) complicated by retinal pigment epithelium tear (RPET), different in involvement of macular zone (MZ), with different time of RPET regarding A-VEGF therapy. Material and methods. The results of treatment 18 patients with wet AMD complicated by RPET during monthly A-VEGF injection were analyzed. In first group (10 eyes) – RPET occurred before treatment, the second (8 eyes) – RPET arisen during A-VEGF. Visometry, ophthalmoscopy, fundus photoregistration, MZ OCT before and in month after each injection. Age – 65–83 years. Results. RPET (1,5 DD) captured fovea in 7 first group patients, in 3 patients RPET (0,5 DD) didn't affect fovea, In macula registered subretinal fluid (SRF) and hemorrhage (SRH). After 2 A-VEGF injections, resorption of SRF and SRH was observed. VA increased from 0,2 to 0,7 in cases RPET without capture of the fovea. RPET involving fovea occurred in 8 patients of the second group after the first A-VEGF injection. SRH and SRF resorbed. VA of patients decreased from 0,7 to 0,15. In both groups relapses of the SRF in macula after the development of RPET were not observed. Conclusion. Wet AMD complicated by RPET as a result of the pathological process and on the background of A-VEGF therapy. When RPET is involved fovea, VA decreases to 0.15. In case of preservation RPE in fovea – VA is high. A-VEGF therapy for wet AMD with RPET leads to resorption of SRH and SRF, to stop SRF for a long time. Key words: wet form macular degeneration, Anti-VEGF therapy, retinal pigment epithelium tear, macular zone

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