Morphologic changes of the double-layer sign during anti-vascular endothelial growth factor therapy in eyes with...

To evaluate longitudinal morphologic changes of the double-layer sign (DLS) on optical coherence tomography (OCT) in eyes with neovascular age-related macular degeneration (nAMD) presenting with exudative macular neovascularization (eMNV) undergoing anti-vascular endothelial growth factor (VEGF) therapy.

This retrospective study included 207 consecutive treatment-naïve eyes (207 patients) with nAMD presenting with eMNV and a DLS treated with intravitreal anti-VEGF injections and were followed for ≥ 12 months. All eyes received 3 monthly loading injections followed by either treat-and-extend (TAE) or pro re nata (PRN) retreatment, per predefined criteria. DLS area, length, and height were measured at baseline, after loading, and 12 months.

All 207 eyes demonstrated significant reductions in mean (± standard deviation) DLS area, length, and height 1 month after the third monthly injection (165 ± 188 µm², 1446 ± 639 µm, and 202 ± 109 µm, respectively) compared with baseline (302 ± 264 µm², 1801 ± 573 µm, and 282 ± 150 µm, respectively) (P = 0.001, P = 0.001, and P = 0.024, respectively). At 12 months the mean change in DLS area was - 141 µm² [95% confidence interval (CI) - 185 to - 98], and median (95% CI) injection number was 8.1 (7.9 to 8.4). Eyes with subretinal and/or intraretinal fluid (SRF/IRF) at 12 months showed re-enlargement of DLS parameters, whereas eyes without SRF/IRF maintained the post-treatment decrease.

DLS morphology regresses after anti-VEGF therapy, and persistent or recurrent fluid is associated with less durable regression. The DLS regresses in response to anti-VEGF therapy, and its behaviour correlates with the clinical course of exudative MNV associated with a DLS. DLS monitoring may complement-but not replace-multimodal imaging when assessing MNV activity.