Retinal Ganglion Cell Layer Change in Patients Treated With Anti-Vascular Endothelial Growth Factor for Neovascular Age-related Macular Degeneration

PurposeTo evaluate macular retinal ganglion cell thickness in patients with neovascular age-related macular degeneration (AMD) and intravitreal anti-vascular endothelial growth factor (VEGF) therapy.DesignRetrospective case series with fellow-eye comparison.MethodsPatients with continuous unilateral anti-VEGF treatment for subfoveal and juxtafoveal neovascular AMD and a minimum follow-up of 24 months were included. The retinal nerve fiber (RNFL) and retinal ganglion cell layer (RGCL) in the macula were segmented using an ETDRS grid. RNFL and RGCL thickness of the outer ring of the ETDRS grid were quantified at baseline and after repeated anti-VEGF injections, and compared to the patients' untreated fellow eye. Furthermore, best-corrected visual acuity (BCVA), age, and retinal pigment epithelium (RPE) atrophy were recorded and correlated with RNFL and RGCL.ResultsSixty eight eyes of 34 patients (23 female and 11 male; mean age 76.7 (SD ± 8.2) with a mean number of 31.5 (SD ± 9.8) anti-VEGF injections and a mean follow-up period of 45.3 months (SD ± 10.5) were included. Whereas the RGCL thickness decreased significantly compared to the noninjected fellow eye (P = .01), the decrease of the RNFL was not significant. Visual acuity gain was significantly correlated with RGCL thickness (r = 0.52, P < .05) at follow-up and negatively correlated (r = −0.41, P < .05) with age. Presence of RPE atrophy correlated negatively with the RGCL thickness at follow-up (r = −0.37, P = .03).ConclusionDuring the course of long-term anti-VEGF therapy there is a significant decrease of the RGCL in patients with neovascular AMD compared to the fellow (untreated) eye.