Improvement of photoreceptor integrity and associated visual outcome in neovascular age-related macular degeneration

Am J Ophthalmol. 2012 Jul;154(1):164-173.e1. doi: 10.1016/j.ajo.2012.01.030. Epub 2012 Apr 26.


Purpose: To evaluate the association between improvement of photoreceptor integrity and visual acuity (VA) after anti-vascular endothelial growth factor (anti-VEGF) injections in neovascular age-related macular degeneration (AMD).

Design: Retrospective, cross-sectional study.

Methods: Eighty-seven eyes of 84 patients who were newly diagnosed with neovascular AMD and treated with anti-VEGF injections were reviewed retrospectively. Using spectral-domain optical coherence tomography, the status of the inner segment/outer segment photoreceptor junction (IS/OS) was graded and classified into 3 groups at baseline and 1 and 2 months after 3 monthly injections. The proportion of the improved IS/OS line after treatment was analyzed and correlated with VA.

Results: The number of eyes in the IS/OS+ group, representing disrupted IS/OS line less than 200 μm, was increased from 9 (10%) at baseline to 33 (38%) at 1 month. There was a significant difference in the ratio of IS/OS+ group between baseline and 1 month (P < .001). Those in the IS/OS± group, showing focal disrupted IS/OS line between 200 and 800 μm, decreased from 29 (33%) to 22 eyes (25%). Improvement of the IS/OS line at 1 month compared to baseline was noted in 43 eyes (49%) and correlated with better VA (P < .016). No increase of VA was observed in 44 eyes without definite improvement. There was no significant correlation between improvement of the IS/OS line and VA from 1 to 2 months.

Conclusions: Assessing the change of the photoreceptor integrity before and after treatment would be a useful indicator to predict initial response to treatment and visual prognosis in patients with neovascular AMD.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / administration & dosage*
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Bevacizumab
  • Cross-Sectional Studies
  • Female
  • Fluorescein Angiography
  • Humans
  • Male
  • Middle Aged
  • Ranibizumab
  • Retinal Photoreceptor Cell Inner Segment / pathology*
  • Retinal Photoreceptor Cell Outer Segment / pathology*
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Visual Acuity / physiology*
  • Wet Macular Degeneration / drug therapy
  • Wet Macular Degeneration / physiopathology*


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Bevacizumab
  • Ranibizumab