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Christian Simader, Sebastian M Waldstein, Michael Larsen, Paul Mitchell, Giovanni Staurenghi, Glenn J Jaffe, Ursula Schmidt-Erfurth; Structure-function correlation of optical coherence tomography features and visual outcome in a fixed and a PRN regimen in neovascular AMD. Invest. Ophthalmol. Vis. Sci. 2014;55(13):868.
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To investigate the correlation of intraretinal, subretinal and sub-pigment epithelial (sub-RPE) pathomorphologic features in optical coherence tomography (OCT) and best-corrected visual acuity (BCVA) during two years of antiangiogenic therapy in neovascular age-related macular degeneration (AMD).
In the VIEW trials, 2457 patients with treatment-naïve neovascular AMD received intravitreal aflibercept or ranibizumab treatment in a fixed (monthly and bimonthly) (Week 0-48) and subsequent pro re nata (PRN) (Week 52-96) regimen (with mandatory dosing quarterly). Standardized OCT evaluation was performed for intraretinal cysts (IRC), subretinal fluid (SRF) and pigment-epithelial detachment (PED).
The presence of IRC at baseline was associated with substantially lower BCVA before therapy. At 48 and 96 weeks, patients who had only SRF at baseline achieved highest BCVA outcomes with more than two lines gained. Patients with both IRC and PED at baseline continuously performed worst. PED lesions also persisted twice as often compared to IRC and SRF. The impact of morphology was independent of the type of regimen and was enhanced by baseline BCVA levels, with a higher impact in eyes with poorer initial VA. The mean VA loss commonly seen with a discontinuous reactive treatment, was driven by the group with PED at baseline, particularly those developing IRC during the PRN regimen and correlated with the frequency of IRC occurrence. While ‘exudative cysts’ resolving during the loading dose, uncommonly recurred, ‘degenerative cysts’ which persisted after the loading phase recurred throughout follow-up. This group also started with a lower baseline BCVA and experienced less visual gain in BCVA than the other groups.
Among the three compartments of intra- /subretinal and sub-RPE fluid, IRC show the strongest impact on visual function both at baseline and on therapeutic BCVA gains. During PRN, PED, likely harbouring the primary neovascular lesion, was associated with IRC recurrence and BCVA decline. Assessment of the pathomorphologic compartments by OCT offers essential insight for the management of antiangiogenic therapy in neovascular AMD.
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