Abstract
Purpose::
Not only the lesion type, but also morphological characteristics offer a predictive value for the efficacy of anti-VEGF treatment in macular edema due to neovascular AMD. We investigated the prognostic influence of distinct morphological changes such as retinal thickening, the presence of cysts, pigment epithelial detachment (PED) and subretinal fluid on retinal function and morphology of anti-VEGF treatment in wet AMD.
Methods::
30 patients presenting with untreated exudative AMD were included for 3 consecutive treatments with intravitreal ranibizumab given at m onthly intervals, the observation period was 4 months. Retinal morphologies were assessed using OCT (OCT-3, Zeiss) following a standardized reading protocol at baseline, 1 week after the first treatment and every 4 weeks prior to the next treatment.
Results::
At baseline, cystic changes were present in 18 lesions with large subfoveal cysts in 13 cases, PED was documented in 15 cases, and subretinal fluid in 20 cases. Central retinal thickness was significantly reduced one week after the initial treatment (from 325 ± 93 at baseline to 241 ± 70 after one week p<0.001), this effect remained stable after a total of 3 treatments. The number of cystic lesions (from 60% at baseline to 24% after one week p<0.005) and of lesions with large central cysts (from 43% at baseline to 6% after one week p<0.001) was also significantly reduced after one week. The proportion of lesions with subretinal fluid was reduced after 4 weeks (from 48% at baseline to 31% after one week p<0.007). These effects also remained stable during the entire follow-up. The number of lesions with PED tended to be reduced during the observation period, this effect was, however, not significant. Whereas visual acuity was not significantly different between lesions types, cystic lesions had significantly lower VA at baseline and after 3 treatments. The improvement in visual acuity after 3 treatments was indirectly correlated to central retinal thickness at baseline (p<0.038).
Conclusions::
Intraretinal cysts and subretinal fluid are significantly and immediately reduced after treatment with ranibizumab. After three treatments, this effect remained stable during the entire observation of 4 months. The gain in visual acuity after 3 treatments is higher in eyes with lower retinal thickness before treatment. The presence or change in PED morphology has little impact on visual outcome. Whether cysts, PED or subretinal fluid have predictive value on long-term prognosis, remains to be elucidated.
Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: systems/equipment/techniques • edema