C Majcher (Salus), SH Sinclair (Drexel Univ School Med), W Li (Drexel Univ School Med), P Presti (Georgia Institute of Technology, Atlanta)

Objective:

Investigate erythropoietin intravitreal injections stabilization of central discriminant visual fields (CDVF) and GA progression in atrophic ARMD and correlate OCT findings with CDVF and patterns of GA progression.

Methods:

Retrospective pilot study of patients with GA AMD with fovea threatened or recently involved. Follow-up examinations every 4 months included OCT, fluorescein angiography, and CDVF. OCT images were analyzed for disruption of inner-segment/outer-segment junction (IS/OS junction), loss of outer plexiform layer (OPL), and RPE redundancy/thickening. Primary outcome was GA progression rate in treated eyes compared with rates prior to treatment. Secondary outcomes were rate of GA progression in treated eyes compared to atrophic fellow eyes, and change in CDVF Global Macular Acuity (GMA) in treated eyes compared with change prior to treatment.

Results:

Eight eyes of 8 patients were treated for an average of 1.54yrs with mean 9.6 injections. Seven were examined averaging 1.3 years prior to treatment with 0.054logMAR decline in ETDRS VA prior to treatment compared with 0.161logMar during treatment. The mean 2.55mm²/yr GA enlargement prior to treatment (initial GA size of 7.50mm²) compared with an enlargement during treatment of 2.06mm²/yr. The CDVF GMA during treatment in 5 eyes improved 0.185 logMAR compared with 0.082 declines prior to treatment. In the 5 fellow eyes (followed for a mean of 2.6yrs), GA progression measured 2.25mm²/yr.
GA was characterized by OCT loss of OS/IS junction and OPL. Disruption of the IS/OS junction often extended beyond GA while RPE thickening lined the boundary. Best indicators of future GA progression were loss of OPL or RPE abnormalities. CDVF scotomas corresponded with OCT OS/IS junction loss.

Conclusions:

In a small pilot study, intravitreal Procrit appeared to slow GA progression and vision loss. OCT and CDVF appear useful for mapping preserved retina and vision, monitoring disease progression, and aid in predicting future GA growth.