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Sukhpal S. Sandhu, Sanjeewa S. Wickremasinghe, Lucy Basija, Jonathan H. Lim, Robyn H. Guymer; Qualitative Appearance of OCT Predicts Visual Outcome at 12 months Following Anti-VEGF Therapy for Neovascular AMD. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5927.
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Following treatment with anti-vascular endothelial growth factor (anti-VEGF) drugs in patients with neovascular age-related macular degeneration (AMD) almost 90% of patients maintain vision, around one third show significant improvement but 10-15% of patients continue to lose vision despite treatment. The aim of this study was to assess whether optical coherence tomography (OCT) following a loading dose of three anti-VEGF injections could predict vision outcome at 12 months after treatment initiation.
Prospective patients receiving anti-VEGF treatment (ranibizumab or bevacizumab) for subfoveal choroidal neovascular membranes (CNVMs) secondary to AMD had information relating to demographics, lesion characteristics, best-corrected LogMAR visual acuity (BCVA) and qualitative OCT data collected at baseline and at each review. The primary outcome measurement was the ability of the OCT following loading dose treatment to predict BCVA outcome at 12 months following anti-VEGF treatment.
A series of 214 patients (age range:58-94 years) were enrolled and monitored over a 12-month period. In one-way-ANOVA analysis, OCT appearance at 3 months was significantly associated with BCVA at 12 months (F(1,147)=9.34,p<0.001). Those who were classified as ‘dry’ at 3 months had a mean BCVA of 0.55(0.39) at 12 months. Those with residual fluid or with hyper-reflectivity at the level of the retinal pigment epithelium (RPE) had BCVA of 0.84(0.54) and 0.91(0.51) respectively, at 12 months. In multivariate-regression analysis (accounting for demographics, smoking, type and size of CNVM, baseline BCVA, and number of injections) those who lost vision at 12 months had much higher odds of having residual fluid (OR=7.04,95%CI:1.40-35.36,p=0.018) or hyper-reflectivity at the level of the RPE (OR=22.40,95%CI:3.42-146.72,p=0.001) at the 3-month assessment.
This study shows that in patients with neovascular AMD, the assessment of OCT at 3 months can be a significant predictor of vision at 12 months. This information could help physicians in assessing potential visual outcome at a relatively early stage in the treatment schedule.
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