Abstract
This study evaluated the characteristic changes in optical coherence tomography (OCT) biomarkers in neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor drugs and their relationship with visual outcomes at 1-year follow-up in a real-world setting. We retrospectively reviewed the medical records of 126 eyes with nAMD treated with either intravitreal ranibizumab or aflibercept, including ophthalmologic examinations and spectral-domain OCT at baseline and months 3, 6, and 12 after first injection. Treatment response of intraretinal cysts (IRCs), subretinal fluid (SRF), and pigment epithelial detachment (PED), and the correlation between best-corrected visual acuity (BCVA) changes and these OCT biomarkers were analyzed. After an average of 5.1 ± 1.5 injections, 33.3% of eyes with PED showed resolution at month 12, a significantly lower proportion than for IRCs (53.8%) or SRF (51.6%). BCVA improvement at 1 year was negatively associated with PED at baseline and with IRCs or PED at month 12. Persistence of IRCs at month 12 was associated with degeneration morphology of IRCs at baseline and non-resolved cysts at month 3 after loading. In conclusions, IRCs and PED are associated with poor visual improvement in nAMD in a real-world setting. Both IRCs and SRF responded better than PED to anti-VEGF therapy.
Highlights
Age-related macular degeneration (AMD) is one of the most common causes of severe visual loss in middleand old-aged populations, and often leads to severe impairments in daily life[1,2]
The real-world results in our study demonstrated a strong correlation between baseline optical coherence tomography (OCT) biomarkers and visual function at both baseline and 1 year in patients with neovascular age-related macular degeneration (nAMD) treated with either ranibizumab or aflibercept
A post hoc analysis of the VIEW studies[12] found that morphologic features detectable on OCT, such as intraretinal cysts (IRCs), subretinal fluid (SRF), and pigment epithelial detachment (PED), were significantly associated with baseline visual acuity and best-corrected visual acuity (BCVA) changes at week 52. They found that IRC at baseline were the most important features associated with both poor baseline visual acuity and lower visual improvement, while SRF at baseline was associated with better BCVA gain, and PED at baseline was associated with reduced BCVA gain
Summary
Age-related macular degeneration (AMD) is one of the most common causes of severe visual loss in middleand old-aged populations, and often leads to severe impairments in daily life[1,2]. The first-line treatment for neovascular AMD (nAMD) is intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs, including bevacizumab, ranibizumab, and aflibercept[3,4,5] During both initial evaluation and treatment follow-up for patients with nAMD, optical coherence tomography (OCT) is often used to predict and evaluate the treatment response as well as to guide the treatment[6,7,8,9,10,11,12]. Schmidt-Erfurth[13] summarized the usefulness of these OCT-based biomarkers in a recent review, based mainly on the results of post hoc analysis of large randomized control trials (RCTs) Many of these early studies used time-domain OCT to evaluate the retinal structures and provided less precise evaluation of the retinal details[6,8,9,10,12]. We retrospectively reviewed all nAMD cases treated with either ranibizumab or aflibercept at a tertiary referral center in Taiwan and evaluated the treatment outcomes along with the OCT biomarkers in these patients to further evaluate the predictive value of these OCT findings in a real-world setting
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