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LONGITUDINAL ANATOMICAL RESPONSE OF RETINAL–CHOROIDAL ANASTOMOSIS TO ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY

2011; Lippincott Williams & Wilkins; Volume: 32; Issue: 3 Linguagem: Inglês

10.1097/iae.0b013e3182205960

1539-2864

Giuseppe Querques, Antoine Rousseau, Raimondo Forte, Claire Scemama, Violane Caillaux, Lea Querques, Eric H. Souied,

Glaucoma and retinal disorders

In Brief Purpose: To evaluate the longitudinal anatomical response of retinal–choroidal anastomosis (RCA) to intravitreal ranibizumab injection using spectral-domain optical coherence tomography (SD-OCT). Methods: We reviewed the medical records of 21 consecutive patients with RCA who underwent intravitreal ranibizumab injections at the University Eye Clinic of Creteil between January 2009 and June 2010. The SD-OCT features at baseline, at 3 months, and at 12 months were retrospectively analyzed. Based on SD-OCT, RCAs were classified as showing a focal retinal pigment epithelium (RPE) erosion ("erosion sign") over a small, localized RPE elevation; a focal RPE break leaving two free RPE flaps ("flap sign") at the level of a small, localized RPE elevation; or a large convex RPE prominence and a focal funnel-shaped RPE kissing an inverted focal funnel-shaped inner neuroepithelium ("kissing sign"). Results: Twenty-one eyes of 21 patients (3 men and 18 women, aged 81.6 ± 6.8 years) diagnosed with RCA naive to any treatment were included for analysis. Spearman ρ correlation between best-corrected visual acuity and lesion classification was 0.54 (P = 0.01) at Month 3 and 0.85 (P < 0.001) at Month 12. Eyes showing the flap sign at baseline underwent significantly less ranibizumab injections after the loading phase (2.14 ± 0.89 vs. 3.40 ± 0.96, P = 0.007) and showed a greater improvement in best-corrected visual acuity at Month 12 (from 0.52 ± 0.14 to 0.38 ± 0.15, P = 0.03) compared with eyes showing the kissing sign. At 12 months, 3 of 10 eyes with flap sign at baseline showed RCA activity, whereas 7 of 10 regressed to erosion sign phase. Of the 10 eyes with kissing sign at baseline, 6 progressed to a fibroglial scar. Conclusion: A flap sign of RCA at baseline seems a favorable prognostic factor as concerns best-corrected visual acuity improvement and the need for retreatment. Based on spectral-domain optical coherence tomography findings, it seems possible to reverse the pathologic phases establishing retinal–choroidal anastomosis with anti–vascular endothelial growth factor treatment. Moreover, the earlier the disease process is identified and treated, the better is the prognosis.