Ji Young Lee; Hyung Chan Kim

doi:10.3341/jkos.2016.57.1.63

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Lee and Kim: Ganglion Cell Layer Thickness after Anti‐ Vascular Endothelial Growth Factor Treatment in Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2015;57(1):63-70.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2016.57.1.63

Ganglion Cell Layer Thickness after Anti‐ Vascular Endothelial Growth Factor Treatment in Retinal Vein Occlusion

Ji Young Lee, M.D, Hyung Chan Kim, M.D, PhD

Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

Address reprint requests to Hyung Chan Kim, MD, PhD Department of Ophthalmology, Konkuk University Medical Center, #120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: 82-2-2030-8180, Fax: 82-2-2030-5273 E-mail: eyekim@kuh.ac.kr

Received 15 May 201523 September 2015 Accepted 20 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effect of repeated intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) on the thickness of the ganglion cell layer (GCL) in patients with retinal vein occlusion.

Methods

The present retrospective study included 60 patients with branch retinal vein occlusion and central retinal vein occlu-sion who received more than 3 anti-VEGF injections. GCL thickness was measured using spectral-domain optical coherence tomography. GCL thickness measurements were made at 9 Early Treatment Diabetic Retinopathy Study grid regions. We eval-uated correlations between changes in the GCL thickness and other factors such as intraocular pressure, times of injection, and changes in central macular thickness (CMT).

Results

As a result of multiple intravitreal anti-VEGF treatments, GCL thickness was significantly decreased from 42.99 ± 5.39 to 38.99 ± 5.53 ( p < 0.001). Changes in GCL thickness were correlated with CMT and the number of injections ( p = 0.02 and p = 0.048, respectively). However, multivariate analysis showed the change in mean GCL thickness in the retinal vein occlusion (RVO) was strongly associated only with CMT ( p < 0.001).

Conclusions

As a result of multiple intravitreal injections of anti-VEGF, GCL thickness decreased significantly in RVO patients and changes in GCL thickness and CMT were correlated.

Keywords: Autosegmentation, Ganglion cell layer, Intravitreal anti-vascular endothelial growth factor injection, Retinal vein occlusion, Spectral domain optical coherence tomography

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Figure 1.

Automatic segmentation of retina by SD-OCT. (A) Segmentation editor view of retina by SD-OCT Spectralis software ver-sion 0.6. A segmentation line marks and belongs to either a certain retinal structure (ILM, ELM, PR1, PR2, RPE, BM) or the outer boundary of a retinal or sub-retinal layer (RNFL, GCL, IPL, INL, OPL, ONL, CHO). (B) Thickness map of GCL, RNFL, and IPL. ILM = internal limiting membrane; RNFL = retinal nerve fiber layer; GCL = ganglion cell layer; IPL = inner plexiform layer; INL = inner nuclear layer; OPL = outer plexiform layer; ELM = external limiting membrane; PR1 = first photoreceptor layer; PR2 = second photoreceptor layer; RPE = retinal pigment epithelium; BM = Bruch's membrane; CHO = choroid; ETDRS = Early Treatment Diabetic Retinopathy Study; SD-OCT = spectral domain optical coherence tomography; ONL = outer nuclear layer.

Figure 2.

Changes in GCL thickness after multiple anti-VEGF injections in BRVO. Right eye of a 60-year-old woman with BRVO. (A) Initial fundus photography and SD-OCT image with retinal hemorrhage at ST area and cystoid macular edema. (B) Initial thick-ness map of GCL in BRVO patient. (C) Fundus photography and SD-OCT image after 7 anti-VEGF injections show reduction of retinal hemorrhage and macular edema. (D) Thickness map of GCL in BRVO patient after 7 anti-VEGF injections. ETDRS = Early Treatment Diabetic Retinopathy Study; GCL = ganglion cell layer; VEGF = vascular endothelial growth factor; BRVO = branch retinal vein occlusion; SD-OCT = spectral domain optical coherence tomography; ST = superotemporal.

Figure 3.

Changes in GCL thickness after multiple anti-VEGF injections in CRVO. Right eye of a 54-year-old man with CRVO. (A) Initial fundus photography and SD-OCT image with diffuse retinal hemorrhage at ST area and cystoid macular edema. (B) Initial thickness map of GCL in CRVO patient. (C) Fundus photography and SD-OCT image after 4 anti-VEGF injections show reduction of retinal hemorrhage and macular edema. (D) Thickness map of GCL in CRVO patient after 4 anti-VEGF injections. ETDRS = Early Treatment Diabetic Retinopathy Study; GCL = ganglion cell layer; VEGF = vascular endothelial growth factor; CRVO = central retinal vein occlusion; SD-OCT = spectral domain optical coherence tomography; ST = superotemporal.

Table 1.

Baseline characteristics of patients

	BRVO	CRVO	Total	p-value
No. of patients (eyes)	35	25	60	-
Male/female	14/21	13/12	27/33	0.434^*
Age (years)	62.54 ± 8.52	64.28 ± 10.67	63.27 ± 9.43	0.509^†
Follow up period (months)	19.54 ± 17.41	22.44 ± 17.16	20.75 ± 17.22	0.467^†
No. of injections	5.26 ± 2.59	6.48 ± 10.67	5.77 ± 3.27	0.329^†
Initial IOP (mm Hg)	14.02 ± 2.37	16.28 ± 2.59	14.97 ± 2.69	0.001^†
Initial CMT (μ m)	385.83 ± 135.94	463.56 ± 158.92	418.22 ± 149.72	0.062^†
Initial average GCLT (μ m)	42.30 ± 4.78	43.94 ± 6.12	42.99 ± 5.39	0.161^†

Values are presented as mean ± SD unless otherwise indicated.

BRVO = branch retinal vein occlusion; CRVO = central retinal vein occlusion; IOP = intraocular pressure; CMT = central macular thick-ness; GCLT = ganglion cell layer thickness.

^* Chi-square test

^† Mann-Whitney test.

Table 2.

Changes in GCL and CMT before and after treatment

	Total (BRVO + CRVO)
	Pre-treatment	Post-treatment	p-value^*
GCLT
Fovea (μ m)	22.20 ± 10.02	18.25 ± 8.25	0.038
SC (μ m)	54.47 ± 7.93	50.02 ± 9.97	<0.001
SP (μ m)	37.37 ± 5.95	34.42 ± 7.57	0.003
NC (μ m)	54.97 ± 7.46	50.97 ± 8.18	<0.001
NP (μ m)	41.55 ± 5.48	40.43 ± 5.80	0.099
IC (μ m)	54.15 ± 11.34	47.98 ± 13.24	<0.001
IP (μ m)	35.60 ± 6.46	33.20 ± 6.72	0.003
TC (μ m)	49.85 ± 8.38	41.87 ± 8.59	<0.001
TP (μ m)	38.05 ± 6.72	33.78 ± 7.08	<0.001
Average	42.99 ± 5.39	38.99 ± 5.53	<0.001
CMT (μ m)	418.22 ± 149.72	306.93 ± 89.02	<0.001

Values are presented as mean ± SD unless otherwise indicated.

GCL = ganglion cell layer; CMT = central macular thickness; BRVO = branch retinal vein occlusion; CRVO = central retinal vein occlu-sion; GCLT = ganglion cell layer thickness; SC = superior-central; SP = superior-peripheral; NC = nasal-central; NP = nasal-peripheral; IC = inferior-central; IP = inferior-peripheral; TC = temporal-central; TP = temporal-peripheral.

^* Paired t-test.

Table 3.

Correlation of changes in GCLT with other variables

Variables	r	p-value^*
Age (years)	0.129	0.326
Changes in IOP	0.082	0.535
Changes in CMT	0.392	0.002
No. of injections	0.256	0.048

GCLT = ganglion cell layer thickness; IOP = intra ocular pres-sure; CMT = central macular thickness.

^* Spearman correlation test.

Table 4.

Multivariate regression analysis^* of variables associated with GCL thickness

Variables	95% CI^*	R-square^*	p-value^*
Changes in CMT	0.0264-0.0577	0.048	<0.001

GCL = ganglion cell layer; CI = confidence interval; CMT = central macular thickness.

^* Multivariate regression analysis after univariate regression 10% selection, backward elimination.

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