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Sanjeewa Wickremasinghe, Farshad Abedi, Sukhpal Singh Sandhu, Amirul Islam, Robyn H Guymer; Qualitative OCT Appearance and Vision Change in Eyes with Neovascular AMD Treated with Anti-VEGF Drugs. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3971.
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Using intravitreal ranibizumab injections for neovascular age related macular degeneration (AMD), we aimed to assess whether there was a correlation between optical coherence tomography (OCT) findings and changes in vision during the treatment period.
Patients with neovascular AMD starting anti-VEGF treatment in 2009, were considered for this study. All eyes were treated with intravitreal ranibizumab using a ‘treat and extend’ strategy. Visual acuity and OCT appearances were assessed at each visit to determine any possible relationship between qualitative changes in OCT and visual outcomes.
Ninety-nine patients (63% female), aged between 65 to 91 years were recruited. Of these patients, four had both eyes treated, leaving a study population of 103 eyes. Mean (± standard deviation) follow up was 634 ±150 days. There were 1.26 ± 1.21 instances (range 0-4) of recurrent intra retinal fluid (IRF) or sub-retinal fluid (SRF) on OCT, whilst 5 or more letters of best-corrected vision (BCVA) was lost on 2.24 ± 1.44 occasions. Eyes that had severe vision loss (≥15 letters) were less likely to recover vision than where vision loss was <5 letters, (21.9% vs. 53.1%, p=0.001). IRF was associated with lower acuity (54.6 letters), than SRF (61.2 letters) or where no fluid was detected (59.4 letters), p<0.001. A new onset of either IRF (33.9%) or SRF (29.6%), was more likely to lead to vision loss, compared to eyes that were dry (16.6%), or that had persistent IRF (11.9%) or persistent SRF (14%), p<0.001. When fluid was persistent (≥3 consecutive visits) however, any loss of vision was associated with a lower chance of recovery than where fluid was on new onset (64.3% vs. 85.3%, p=0.04).
The presence of IRF was associated with poorer vision than where eyes were dry or only had SRF. The development of new fluid on OCT was more likely to lead to a loss in visual acuity than where there was no fluid or where fluid was persistent, suggesting that small amounts of stable fluid could be tolerated without compromising vision. In these cases however, any increase in fluid should be treated aggressively since visual recovery was less likely where there was any loss in acuity.
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