Zeitschrift für klinische und experimentelle Ophthalmologie
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Prognostic Factors for Long Term Visual Acuity Outcome after Ranibizumab Therapy in Patients with Neovascular Age-Related Macular Degeneration

Tina Ristau, Steffen Hillebrand, Dzenita Smailhodzic, Alexander C. Walsh, Bernd Kirchhof, Srinivas R. Sadda and Sandra Liakopoulos

Purpose: To evaluate whether spectral domain optical coherence tomography (SDOCT) and fluorescein angiography (FA) findings are predictive of visual acuity (VA) outcome after ranibizumab for neovascular age-related macular degeneration (NVAMD).
Methods: Best corrected VA of 72 previously untreated eyes with NVAMD were retrospectively collected at baseline, after 3 injections and at 12, 24 and 36 months follow-up, if available. FA and SDOCT images at baseline were qualitatively and quantitatively analyzed using reading center software. The area of CNV lesion components on FA as well as the volume of the neurosensory retina, the outer nuclear layer, subretinal fluid, subretinal hyperreflective material and pigment epithelial detachment (PED) on SDOCT were calculated. VA as well as change in VA from baseline were correlated with all parameters.
Results: VA at baseline significantly correlated with final VA as well as change in VA during follow-up. A greater area of total CNV lesion, classic as well as occult CNV lesion components on FA correlated with lower VA during follow-up. Qualitative features that indicated better short-term outcomes included the presence of retinal angiomatous proliferation (RAP) and the absence of cystoid spaces on SDOCT. Eyes with a larger retinal volume demonstrated a greater short-term increase in VA, eyes with larger PED volume and area measurements on OCT demonstrated less VA increase after 12 months. Lower VA outcomes were seen in eyes with larger volume of subretinal hyperreflective material or larger area of PED, as well as lower volume of the outer nuclear layer. No prognostic value could be identified for CNV lesion types other than RAP, subretinal fluid, gender and age.
Conclusions: Several FA and SDOCT parameters showed prognostic value for VA outcome after ranibizumab in NVAMD. A larger, prospective dataset will be crucial for defining the relative importance of these parameters.