Purpose:
Organized scar tissue is commonly seen after different wet AMD treatment modalities, whether PDT, TPPV, or anti-VEGF, alone or in combination. We wished to characterize the relationship between final visual acuity and OCT and FA structural findings in a group of CNV patients with extensive retinal scarring after being treated for wet age-related macular degeneration.
Methods:
A retrospective study of 78 eyes of 65 patients with extensive subfoveal scarring after treatment for wet AMD, at Shiley Eye center and Jacobs Retina Center, UCSD, within the last 2 years were analyzed. Final best-corrected ETDRS visual acuity data was also collected as was demographic data, treatment history, as well as fundus fluorescein angiography and SD-OCT parameters within central 1000 microns, such as IS/OS junction and ELM integrity, subretinal scar area, and presence of central island of intact retinal tissue on FA. A multivariable regression analysis was performed with final BCVA Log MAR as a response, and the above-identified OCT and FA variables as predictors.
Results:
The BCVA ranged from HM to 20/40. Despite the presence of extensive scarring, 8 eyes (10%) had 20/80 or better vision, and it was 20/160 or better in 21 eyes (27%). There was a statistically significant correlation between good visual acuity and the presence of central island on FA (p=0.0001). The area of scar was negatively correlated with acuity. There was no correlation between the final BCVA and other OCT parameters (IS/OS and ELM integrity, presence of intra- or subretinal fluid, PED, overlying foveal thickness, type of treatment received).
Conclusions:
Final BCVA was negatively associated with the subretinal scar area, but positively associated with the presence of an central island of less fibrosis and staining on FA. Some patients had good visual acuity, despite the extensive damage to the outer retinal structures. The presence of subretinal fibrosis in AMD patients does not always predict a poor visual recovery.
Keywords: visual acuity • age-related macular degeneration • imaging/image analysis: clinical