Influence of Axial Length on Recurrence of Wet Age-related Macular Degeneration after Initial Treatment

Soo Yeon Cho; Youn Gon Lee; Sang Yun Han; Kee Sun Tae; Jong Woo Kim; Chul Gu Kim; Dong Won Lee; Jae Hui Kim

doi:10.3341/jkos.2019.60.1.47

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Cho, Lee, Han, Tae, Kim, Kim, Lee, and Kim: Influence of Axial Length on Recurrence of Wet Age-related Macular Degeneration after Initial Treatment

Original Article

J Korean Ophthalmol Soc 2019;60(1):47-54.

Published online: 25 September 2019

DOI: https://doi.org/10.3341/jkos.2019.60.1.47

Influence of Axial Length on Recurrence of Wet Age-related Macular Degeneration after Initial Treatment

Soo Yeon Cho, MD¹, Youn Gon Lee, MD¹, Sang Yun Han, MD¹, Kee Sun Tae, MD², Jong Woo Kim, MD¹, Chul Gu Kim, MD¹, Dong Won Lee, MD¹, Jae Hui Kim, MD^1,

¹Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea

²Tae Eye Clinic, Seoul, Korea

Address reprint requests to Jae Hui Kim, MD Kim's Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 07361, Korea Tel: 82-2-2671-7665, Fax: 82-2-2671-6359 E-mail: kjh7997@daum.net

Received 30 November 2017 Revised 19 April 2018 Accepted 20 December 2018

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 influence of axial length on the recurrence of wet age-related macular degeneration (AMD) after an-ti-vascular endothelial growth factor therapy.

Methods

A retrospective review of the medical records for 45 eyes of 45 patients, who were diagnosed with neovascular AMD and treated with three ranibizumab injections per month, was performed. Axial length was compared between eyes with (recurrence group) and without (no recurrence group) recurrence of fluid during a 12-month follow-up period. In eyes with recurrence, the association between axial length and the time between the third injection and the first recurrence was also evaluated.

Results

The axial length was measured at a mean of 20.6 ± 10.1 months after the diagnosis of neovascular AMD. The mean axial length at that time was 23.33 ± 0.90 mm. The mean axial length was 23.29 ± 0.96 mm in the recurrence group (n = 30) and 23.40 ± 0.79 mm in the no-recurrence group (n = 15). There was no difference in the axial length between the two groups (p = 0.709). In the recurrence group, the period between the third injection and the first recurrence was not associated with axial length (p =0.582).

Conclusions

There was no significant difference in axial length between eyes with and without recurrence after initial treatment for wet AMD. In addition, the time to first recurrence was not significantly associated with axial length. Because the present study was retrospective and the sample size was small, further prospective studies with a better design are needed to more accurately assess the influence of axial length.

Keywords: Age-related macular degeneration, Anti-vascular endothelial growth factor, Axial length, Choroidal neovascularization, recurrence

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Figure 1.

A scatter plot showing association between axial length and the interval between the initial loading phase and the recurrence (n = 30). There was no significant association between the two factors (p = 0.582).

Figure 2.

A Kaplan-Meier graph showing cumulative incidence of recurrence, when divided into two groups, according to axial length. There was no significant difference in the recurrence between the short axial length group (n = 21, solid line) and long axial length group (n = 24, dotted line) (p = 0.409).

Table 1.

Baseline characteristics of 45 patients (45 eyes) who were diagnosed with neovascular age-related macular degeneration

Characteristic	Value
Age (years)	76.1 ± 5.5
Sex
Men	25 (55.6)
Women	20 (44.4)
Hypertension	29 (64.4)
Diabetes mellitus	9 (20.0)
Lens status
Phakia	45 (100)
Axial length (mm)	23.33 ± 0.90
Period between the diagnosis of neovascular AMD and axial length measurement (months)	20.6 ± 10.1
Types of neovascular AMD
Typical neovascular AMD	15 (33.3)
Polypoidal choroidal vasculopathy	14 (31.1)
RAP	8 (17.8)
ICGA images unavailable	8 (17.8)
Best-corrected visual acuity (logMAR)	0.65 ± 0.33

Data are presented as the mean ± standard deviation or number (%). AMD = age-related macular degeneration; RAP = retinal angiomatous proliferation; ICGA=indocyanine-green angiography; logMAR = logarithm of the minimal angle of resolution.

Table 2.

Comparison of axial length and other characteristics between patients with and without recurrence during the 12 months fol-low-up period

Characteristic	With recurrence (n = 30)	Without recurrence (n = 15)	p-value
Axial length (median value, mm)	23.29 ± 0.96 (23.37)	23.40 ± 0.79 (23.26)	0.709^*
Age (years)	76.3 ± 5.7 (76.0)	75.7 ± 5.3 (77.0)	0.743^*
Sex			0.671^†
Men	16 (53.3)	9 (60.0)
Women	14 (46.7)	6 (40.0)
Hypertension	17 (56.7)	11 (73.3)	0.277^†
Diabetes mellitus	6 (20.0)	2 (13.3)	0.699^‡
Types of neovascular AMD			1.000^‡
Typical neovascular AMD + RAP	15 (50.0)	8 (53.3)
Polypoidal choroidal vasculopathy	10 (33.3)	4 (26.7)
Best-corrected visual acuity (logMAR, median value)	0.61 ± 0.29 (0.40)	0.72 ± 0.38 (0.70)	0.339^*

Analysis regarding types of neovascular AMD was performed based on 37 eyes with available indocyanine-green angiography result. Values are presented as the mean ± standard deviation or number (%). AMD = age-related macular degeneration; RAP = retinal angiomatous proliferation; logMAR = logarithm of the minimal angle of resolution.

^* Statistical analysis performed using independent samples t-test

^† Statistical analysis performed using Chi-square test

^‡ Statistical analysis performed using Fisher's exact test.

Table 3.

Comparison of axial length betw without recurrence when divided into tw the subtypes of neovascular age-related ween patients with and o groups, according to macular degeneration

Characteristic	Axial length
Typical neovascular AMD + RAP (n = 23)
With recurrence (n = 15) (median value)	23.25 ± 1.21 (23.76)
Without recurrence (n = 8) (median value)	23.49 ± 0.72 (23.19)
p-value^*	0.636
Polypoidal choroidal vasculopathy (n = 14)
With recurrence (n = 10) (median value)	23.42 ± 0.66 (23.37)
Without recurrence (n = 4) (median value)	23.95 ± 0.54 (24.01)
p-value^*	0.142

Value are presented as the mean ± standard deviation where applicable. AMD = age-related macular degeneration; RAP = retinal angiomatous proliferation.

^* Statistical analysis performed using Mann-Whitney U test.

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