gms | German Medical Science

Purpose: Standardized analysis of morphological OCT parameters and correlation with best-corrected visual acuity (BCVA) in antiangiogenic therapy of neovascular age-related macular degeneration (AMD).

Methods: 1240 patients were treated using ranibizumab/aflibercept in a fixed (year one) and a PRN (year two) regimen in a prospective randomized trial (VIEW2). OCT data were obtained monthly by a standardized protocol and analyzed by an independant reading center.

Results: At baseline, 64% of eyes demonstrated intraretinal cysts (IRC), 80% pigment epithelial detachment (PED) and 84% subretinal fluid (SRF). IRC (p<0.0001) and PED (p=0.028) were associated with a lower initial BCVA. During the loading dose, 75% of SRF, 70% of IRC and 25% of PED resolved under treatment. Functional and morphologic benefit were maintained throughout the fixed regimen. At one year, best outcomes were achieved in SRF only with a mean improvement of +12 letters, results were least favourable in IRC+PED with +6 letters only. Switching to a PRN regimen introduced BCVA loss associated with occurrence of novel IRC, while eyes without IRC maintained vision in all groups despite fewer treatments. IRC had a negative impact on final BCVA, with a combination of IRC and PED showing the worst prognosis.

Conclusion: Correlation of OCT and BCVA values revealed a significant negative impact of intraretinal cysts on baseline as well as final BCVA. Occurrence of novel IRC was associated with BCVA loss during the PRN regimen. Intraretinal cystic changes may indicate progression of degenerative disease. Qualitative morphological parameters obtained by OCT correlate with vision outcome and offer adequate guidance for optimal management of antiangiogenic therapy in neovascular AMD.