Changes in cone-driven functions after intravitreal aflibercept injections in patients with age-related macular degenera
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ORIGINAL RESEARCH ARTICLE
Changes in cone-driven functions after intravitreal aflibercept injections in patients with age-related macular degeneration Tomoharu Nishimura . Shigeki Machida
. Yuji Hara
Received: 5 September 2019 / Accepted: 18 February 2020 Ó Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To determine the changes in the conedriven functions in patients with age-related macular degeneration (AMD) treated with intravitreal aflibercept. Methods We studied 44 eyes of 44 patients diagnosed with AMD whose mean age was 75 years. The contralateral unaffected eyes served as controls. All patients were initially treated with 3 consecutive monthly intravitreal aflibercept injections and thereafter with bimonthly injections for 12 months. Fullfield cone electroretinograms (cone ERGs) were recorded at the baseline and at 3, 6, and 12 months after beginning the intravitreal aflibercept injections. The cone ERGs were elicited by red stimuli on a blue background. The focal macular ERGs (fmERGs) were elicited by 15 degrees white stimulus spot centered on the fovea. The amplitudes of the a- and b-waves, photopic negative response (PhNR), and sum of the oscillatory potentials (ROPs, sum of OP1–3 amplitudes) were analyzed. In addition, the implicit times of the a- and b-waves were also analyzed. Results The amplitudes and implicit times of all components of the fmERGs were significantly improved compared to the baseline at 3 months after
T. Nishimura S. Machida (&) Y. Hara Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, 2-1-50 MinamiKoshigaya, Koshigaya, Saitama 343-8555, Japan e-mail: [email protected]
beginning the intravitreal aflibercept injections (P \ 0.0005–0.05). The amplitudes of the a-waves and PhNRs were further increased during the maintenance phase (P \ 0.005–0.01). On the other hand, the amplitudes of the full-field a-waves and PhNR of the cone ERGs were significantly reduced at 6 and 12 months compared to the baseline. Conclusions The macular function improved continuously during the maintenance phase of the intravitreal aflibercept injections. In contrast, the conedriven functions of the more peripheral retina decreased with repeated injections suggesting adverse effects of the intravitreal aflibercept injections on the function of the more peripheral normal retina. Keywords Cone function AMD Focal macular ERG Cone ERG Aflibercept
Introduction Age-related macular degeneration (AMD) is a chronic progressive disorder with a severe reduction in the central vision that develops because of aging changes of the retinal pigment epithelium (RPE), Bruch’s membrane, and choriocapillaris in the macular region. AMD is most commonly treated by intravitreal injections of an anti-vascular endothelial growth factor (anti-VEGF) agent, and this type of therapy
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has proven to be very effective in improving the visual function and macular structure [1–4]. Aflibercept is a s
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