Association between Foveal Photoreceptor Integrity and Visual Outcome in Neovascular Age-related Macular Degeneration

• Published in: American journal of ophthalmology 2009-07, Vol.148 (1), p.83-89.e1
• Main Authors: Hayashi, Hisako, Yamashiro, Kenji, Tsujikawa, Akitaka, Ota, Masafumi, Otani, Atsushi, Yoshimura, Nagahisa
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - physiopathology; Coloring Agents; Female; Fluorescein Angiography; Follow-Up Studies; Fovea Centralis; Humans; Indocyanine Green; Macular degeneration; Macular Degeneration - drug therapy; Macular Degeneration - physiopathology; Male; Medical imaging; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Patients; Photochemotherapy; Photodynamic therapy; Photoreceptors; Retina; Retinal Photoreceptor Cell Inner Segment - pathology; Retinal Photoreceptor Cell Outer Segment - pathology; Retinopathies; Retrospective Studies; Standard deviation; Studies; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2009.01.017

Purpose To evaluate the correlation between visual outcome and foveal photoreceptor integrity after successful treatment of eyes with neovascular age-related macular degeneration (AMD). Design Retrospective chart review. Methods We retrospectively studied the medical records of 51 eyes of 51 patients with neovascular AMD who were treated successfully with photodynamic therapy (PDT). All eyes were followed-up for more than 24 months after the initial treatment. Using spectral-domain optical coherence tomography, the status of the inner segment and outer segment (IS/OS) photoreceptor junction was assessed as a hallmark of the integrity of the foveal photoreceptor layer. Results At the final visit, no eyes showed an exudative change. A complete or discontinuous IS/OS line was detected beneath the fovea in 8 (15.7%) and 25 (29.4%) eyes, respectively, whereas 28 (54.9%) had no IS/OS line. Eyes with a continuous or discontinuous IS/OS line beneath the fovea had better final visual acuity (VA) than did eyes without an IS/OS line ( P < .001, respectively). Of the 51 eyes, 36 showed polypoidal choroidal vasculopathy (PCV), whereas 15 were diagnosed as having typical AMD without PCV. Visual outcome was significantly better in eyes with PCV ( P = .026). Most eyes (13/15; 86.7%) with typical AMD had no IS/OS line at the final visit, whereas only 13 (36.1%) of the 36 eyes with PCV had no IS/OS line beneath the fovea. Conclusions Integrity of the photoreceptor layer beneath the fovea is associated with the final VA in neovascular AMD after successful PDT.