Evaluating the risk of recurrence in neovascular age-related macular degeneration using OCT-angiography at the time of treatment exit
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Published on: August 11, 2023
Damian Jaggi1, Sina Marugg2, Lieselotte E Berger2
1Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland damian.jaggi@insel.ch.
Background/Aims:
To find biomarkers on OCT-angiography (OCT-A) that indicate a higher risk of recurrence in neovascular age-related macular degeneration (nAMD) patients before anti-vascular endothelial growth factor (anti-VEGF) therapy termination.
Methods:
Retrospective, observational study. Stable, inactive nAMD patients who had been treated with a treat-and-extend regimen and met the predefined exit criteria were included. The macular neovascularisation (MNV) lesion was imaged on OCT-A. Lesion area, vessel density (VD), fractal dimension and height of feeder vessel were quantified. Patients with disease recurrence after termination were compared with those who stayed inactive.
Results:
Out of 819 eyes diagnosed with nAMD and 281 with a 2-year follow-up, 77 (27.4%) reached the exit criteria. Thirty-four eyes of 33 (15 female) patients with reliable OCT-A were further analysed. Mean age was 80.35 (±9.29) years, the number of injections was 16.68 (±8.22). Treatment duration before exit was 36.15 (±16.63) months. After exit, 23 eyes stayed inactive for a follow-up period of 23.00 (±16.18) months, and 11 experienced recurrence after 13.36 (±9.90) months. VD was significantly higher in the recurrent versus inactive group with 0.60 (±0.15) versus 0.47 (±0.11), p=0.015. There was an insignificant tendency for the protective properties of type 1 MNV and a low feeder vessel.
Conclusion:
OCT-A is useful in the risk calculation for recurrence in patients who are about to discontinue anti-VEGF treatments in nAMD. Patients with a high VD might need closer follow-ups or continued anti-VEGF treatments even if inactive.
