Ellipsoid zone integrity is impaired in patients with neovascular age-related macular degeneration (AMD). However, a study shows “progressive recovery” of this part of the fovea during anti–vascular endothelial growth factor (anti-VEGF) therapy, according to a study published in Retina.

The study’s purpose was to quantify the morphologic photoreceptor integrity in patients with AMD undergoing anti-VEGF therapy. The study, a post hoc analysis of results of a multicenter, prospective trial, was based on the results of the spectral-domain optical coherence tomography (SD-OCT) data of 185 patients at baseline, 3 months, and 12 months. 

Researchers manually quantified loss of the ellipsoid zone , part of the retina’s photoreceptor substructures, in all SD-OCT volumes. They also automatically segmented intraretinal cystoid fluid, subretinal fluid (SRF), and pigment epithelial detachments in full volumes with validated deep learning methods. In addition, they performed patiotemporal correlation of fluid markers with ellipsoid zone integrity and a bivariate analysis between ellipsoid zone integrity and best-corrected visual acuity.

They reported a change in the integrity of the ellipsoid zone from baseline to post-anti-VEGF treatment. Ellipsoid zone improvements were seen more in areas with subretinal fluid, the topographic analysis found. Additionally, a correlation was noted between ellipsoid zone integrity and subretinal fluid resolution, while ellipsoid zone integrity was associated with best-corrected visual acuity throughout the study’s time period.


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“Improvement of ellipsoid zone integrity during anti-VEGF therapy of neovascular age- related macular degeneration occurred predominantly in the fovea. Photoreceptor integrity correlated with best-corrected visual acuity. Ellipsoid zone integrity was preserved in areas of SRF and showed deterioration upon subretinal fluid resolution,” according to the researchers.

The study speculates that “the availability of automated photoreceptor segmentation methods based on artificial intelligence will offer novel horizons to quantify photoreceptor status in clinical practice in the future.”

The study’s limitations include its retrospective nature and that it looked just at the ellipsoid zone band, “only one of the morphologic structures attributable to photoreceptors on OCT images.” 

Reference

Riedl S, Cooney L, Grechenig C, et al. Topography analysis of photoreceptor loss correlated with disease morphology in neovascular age-related macular degeneration. Retina. 2020;40(11):2148–2157. doi: 0.1097/IAE.0000000000002717