Abrupt visual loss during anti-vascular endothelial growth factor treatment for type 3 neovascularization

Abstract

Aim: To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor (VEGF) treatment for type 3 neovascularization.

Methods: This retrospective study included 137 eyes that were newly diagnosed with type 3 neovascularization. All eyes were treated with anti-VEGF therapy. Abrupt visual loss was defined as loss of 5 or more lines in best-corrected visual acuity (BCVA) in comparison to the previous visit. The incidence and timing of abrupt visual loss as well as the factors associated with it, were determined. In addition, the BCVA at the final follow-up was compared between the eyes with and those without abrupt visual loss.

Results: The mean follow-up period was 42.4±18.9mo after diagnosis, and abrupt visual loss was noted in 22 eyes (16.1%) at a mean of 19.6±13.9mo. Abrupt visual loss was found to be associated with subretinal hemorrhage in 11 eyes (50.0%), development of or increase in the height of pigment epithelial detachment with fluid in 8 eyes (36.4%), and tears in the retinal pigment epithelium in 3 eyes (13.6%). The logarithm of minimum angle of resolution (logMAR) mean BCVA at the final follow-up was 2.07±0.67 (Snellen equivalents: 20/2349) and 1.00±0.55 (20/200) in eyes with and without abrupt visual loss, respectively. BCVA was significantly worse in the eyes with abrupt visual loss (P<0.001).

Conclusion: Abrupt visual loss is noted in 16.1% of patients with type 3 neovascularization and is associated with poor visual outcome. Additional studies are needed to determine how abrupt visual loss can be prevented.

Keywords: age-related macular degeneration; hemorrhage; pigment epithelial detachment; retinal angiomatous proliferation; tear in retinal pigment epithelium; type 3 neovascularization.

Figures

Figure 1. A representative figure showing measurement of maximum height and width of PED

Panels A and B comprise different OCT raster scan sections from a single patient. A: Maximum height; B: Maximum width.

Figure 2. Changes in logMAR BCVA, according to the follow-up period

A: Changes in all 137 patients; B: Changes in the abrupt visual loss group (n=22, solid line, closed circle) and non-abrupt visual loss group (n=115, dashed line, closed square). aSignificant difference between the 2 groups (Mann-Whitney U test with Bonferroni's correction, P<0.001).

Figure 3. Timing of the development of abrupt visual loss, stratified according to etiology.

Figure 4. Clinical course of 3 patients with abrupt visual loss

Each case shows the development of subretinal hemorrhage (A-D; A-C: at the baseline, D: when abrupt visual loss developed), PED with fluid (E-H; E-G: at the baseline, H: when abrupt visual loss developed), and tears in the RPE (I-M; I-K: at the baseline, L, M: when abrupt visual loss developed). A, D, E, I, L: Fundus photography image; B, F, J: Indocyanine-green angiography image; C, G, H, K, M: OCT image.

Figure 5. Proportion of patients stratified according to BCVA

A: Abrupt visual loss group (n=22, final visit: 46.2±20.3mo); B: Non-abrupt visual loss group (n=115, final visit: 41.9±18.7mo).