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Erdal Tahmaz, Robert Hoerster, Anna Anselm, Philipp Muether; Early identification of high-risk patients for visual decay in neovascular age related macular degeneration by SD-OCT.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2373.
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Antibodies against vascular endothelial growth factor (VEGF) are able to preserve and increase visual acuity (VA) in neovascular age related macular degeneration (nAMD). However several patients experience severe visual decay despite intensive anti-VEGF-therapy. We aimed to early identify a phenotype of choroidal neovascularization in spectral-domain optical coherence tomography (SD-OCT), prone to visual decay during long term follow up.
At the Department of Ophthalmology, University of Cologne, Germany 71 patients with neovascular AMD were analyzed prospectively over 24 months. Patients received three initial consecutive monthly intravitreal ranibizumab injections followed by monthly SD-OCT controls. Therapy was continued as a pro re nata regimen. Volumetric analysis of SD-OCT images was performed using commercially available software (3D-Doctor). Components of the choroidal neovascularization (CNV) were termed subretinal fluid (SRF), subretinal tissue (SRT) and fibrovascular and serous pigmentepithelial detachment (FPED and SPED respectively).
We subdivided patients in three groups according to their visual outcome after 24 months: group functional win (gaining ≥ 5 letters ETDRS), group functional loss (losing ≥ 5 letters ETDRS and group stable (the patients in between). FPED was not affected by therapy in any of the groups. While group functional win and group stable showed sustained suppression of SRT, SRF and SPED (Figure 1 A, B), group functional loss showed an undulating pattern of decreasing and increasing SPED and SRF upon initiation and discontinuation of therapy respectively (Figure 1 C).
The undulating pattern of recurrent SPED and consecutive SRF could be responsible for visual decay. Switching therapy from pro re nata to a fixed dosing regimen may prevent visual decay in high-risk patients with this CNV-phenotype.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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