Korean J Ophthalmol.  2016 Apr;30(2):114-120. 10.3341/kjo.2016.30.2.114.

Longitudinal Changes in Retinal Nerve Fiber Layer Thickness after Intravitreal Anti-vascular Endothelial Growth Factor Therapy

• Jo YJ
• Kim WJ
• Shin IH
• Kim JY

• KMID: 2160461
• DOI: http://doi.org/10.3341/kjo.2016.30.2.114

Abstract

PURPOSE
To determine the effects of intravitreal anti-vascular endothelial growth factor (VEGF) on thickness of the retinal nerve fiber layer (RNFL) in patients with age-related macular degeneration.
METHODS
Twenty eyes of 20 patients diagnosed with age-related macular degeneration who underwent intravitreal anti-VEGF injection were studied. Postinjection RNFL thickness was measured using optical coherence tomography. Average thickness, four-quadrant RNFL thicknesses, and intraocular pressure (IOP) in affected eyes were measured before and 6 and 12 months after anti-VEGF injection for comparison. RNFL thickness and IOP in affected and normal fellow eyes were also compared. Given that macular lesions can affect RNFL thickness, the changes in thickness were evaluated by dividing the 12 clock-hour RNFL into the pathologic areas adjacent to the lesion and the non-pathologic area.
RESULTS
The mean clock-hour segment in the pathologic area was 4.8 hours. A significantly thicker RNFL was exhibited in temporal quadrants and pathologic areas (p = 0.043 and 0.048, respectively) in affected eyes before injection compared to the baseline RNFL thickness in normal eyes. No significant differences were found in RNFL thickness or IOP between affected and normal eyes after injection. The changes over time in the temporal and pathologic areas were statistically significant at 6 and 12 months after injection compared to baseline data (p < 0.05). No significant differences were displayed in RNFL thickness in the other three quadrants or in non-pathologic areas in either affected or normal eyes. Sequential changes in RNFL thickness in affected eyes were not significant.
CONCLUSIONS
Repeat intravitreal anti-VEGF treatment did not have a significant effect on RNFL thickness. RNFL thickness significantly decreased with time in the pathologic areas and in the temporal segment adjacent to exudative macular lesions. The reduction in RNFL thickness was most likely associated with changes in the macular lesion rather than with anti-VEGF injection.

Keyword

Anti-vascular endothelial growth factor; Optical coherence tomography; Retinal nerve fiber layer

MeSH Terms

Endothelial Growth Factors*
Humans
Intraocular Pressure
Macular Degeneration
Nerve Fibers*
Retinaldehyde*
Tomography, Optical Coherence
Endothelial Growth Factors
Retinaldehyde

Figure

• 

  Fig. 1 Fundus photograph and retinal nerve fiber layer thickness analysis of (A) the right affected eye and (B) the left normal fellow eye of a patient with age-related macular degeneration. The red and black arrows represent the pathologic and non-pathologic areas in the affected eye, respectively. The green and blue arrows represent the same area in the unaffected eye, respectively.

• 

  Fig. 2 Longitudinal changes in average and quadrant retinal nerve fiber layer (RNFL) thickness in affected eyes. The differences between baseline and postinjection at 6 months (p = 0.012) and 12 months (p = 0.006) were statistically significant in the temporal areas. *p < 0.05, Wilcoxon signed-rank test.

• 

  Fig. 3 Longitudinal changes in average retinal nerve fiber layer (RNFL) thickness in the pathologic and non-pathologic areas of affected eyes. The differences between baseline and post-injection at 6 months (p = 0.011) and 12 months (p = 0.005) were statistically significant in the pathologic areas. *p < 0.05, Wilcoxon signed-rank test.

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