OCT predictors of retinal atrophy in neovascular age-related macular degeneration treated with aflibercept

To identify optical coherence tomography (OCT) features present at the diagnosis of neovascular age-related macular degeneration (nAMD) that could predict retinal atrophy (RA) and visual performance in patients treated with intravitreal aflibercept.

OCT data collected at the time of nAMD diagnosis (T0), after the first (T1) and third (T2) intravitreal aflibercept injection, and 5y post-diagnosis (T3) were analyzed. The study included 46 eyes from patients undergoing treatment. The association of OCT features with RA and visual acuity (VA) development over time were evaluated.

Patients with RA at T3 exhibited worse VA (35.19±5.7 vs 8.90±2.3, P<0.001) and a lower rate of improvement or stability at T2 (90.48% vs 56.00%, P=0.019) and T3 (85.71% vs 8.00%, P<0.001). The development of RA at T3 was linked with type 2 macular neovascularization (MNV; 4.76% vs 36.00%, P=0.013), thinner outer nuclear layer (ONL, 88.89±7.82 µm vs 71.38±14.14 µm, P=0.033), presence of intraretinal fluid (IRF, 42.86% vs 80.00%, P=0.014), presence of IRF without subretinal fluid at T0 (SRF, 4.76% vs 32.00%, P=0.027), and reduced central foveal thickness at T3 (CFT, 190.14±22.79 µm vs 124.32±14.35 µm, P<0.001). The presence of SRF with or without IRF at the diagnosis was comparable between the two groups (90.48% vs 68.00%; P=0.084).

Type 2 MNV, reduces ONL and CFT, and IRF presence at baseline may signal a higher risk of RA in treatment-naive nAMD patients, underscoring the importance of these OCT features in early risk assessment and management strategies.