Inner nuclear layer cystoid spaces are a poor prognostic factor in typical age-related macular degeneration and...

To investigate predictive factors for changes in best-corrected visual acuity (BCVA) at 24 months after intravitreal ranibizumab (IVR) for neovascular age-related macular degeneration (nAMD).

This retrospective study included 55 eyes of 55 consecutive patients (32 men and 23 women) with nAMD who received three consecutive monthly IVR injections and were re-treated as needed over a 24-month period. We used the mean changes in logarithm of the minimal angle of resolution (logMAR) BCVA at 24 months as the dependent variable in regression analysis.

The presence of intraretinal cystoid spaces in the inner nuclear layer (INLc, P = 0.004) and baseline subfoveal choroidal thickness (SFCT, P = 0.013) predicted BCVA changes from baseline to 24 months. The presence of INLc and thinning of SFCT were associated with decreased BCVA at 24 months. Thirty-five eyes without INLc showed improved logMAR BCVA, from 0.550 ± 0.273 to 0.368 ± 0.274 (P = 0.045); however, 20 eyes with INLc showed decreased logMAR BCVA, from 0.708 ± 0.347 to 0.971 ± 0.523 (P < 0.001) through the 24-month follow-up. The mean number of IVR injections during the follow-up period was 8.74 ± 4.76 in eyes without INLc and 10.63 ± 4.72 in eyes with INLc, without a statistically significant difference (P = 0.144).

Eyes with INLc or thinned SFCT showed worse visual outcomes compared with eyes without the INLc or with thick SFCT. Furthermore, eyes without INLc showed improved BCVA; however, eyes with INLc showed decreased BCVA with an as-needed regimen.