Short-term response to anti-VEGF as indicator of visual prognosis in refractory age-related macular degeneration

• Published in: Eye (London) Vol. 38; no. 7; pp. 1342 - 1348
• Main Authors: Gigon, Anthony, Iskandar, Antonio, Kasser, Sophie, Naso, Sacha, Zola, Marta, Mantel, Irmela
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.05.2024; Nature Publishing Group
• Subjects: 692/308/53/2422; 692/699/3161/1626; Acuity; Age; Aged; Aged, 80 and over; Angiogenesis Inhibitors - therapeutic use; Artificial intelligence; Atrophy; Bevacizumab - therapeutic use; Epithelium; Female; Humans; Intravitreal Injections; Laboratory Medicine; Macular degeneration; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Ophthalmology; Pharmaceutical Sciences/Technology; Prognosis; Ranibizumab - administration & dosage; Ranibizumab - therapeutic use; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Retrospective Studies; Subretinal Fluid; Surgery; Surgical Oncology; Tomography, Optical Coherence - methods; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - physiology; Wet Macular Degeneration - diagnosis; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - physiopathology
• ISSN: 0950-222X; 1476-5454; 1476-5454
• DOI: 10.1038/s41433-023-02900-6

Background Some patients with neovascular age-related macular degeneration (nAMD) respond insufficiently to anti-VEGF treatment despite maximal monthly intravitreal injections. Their short-term response between injections was investigated for extent and visual prognosis. Subjects/Methods Monocentric retrospective observational study. 45 eyes from 41 patients with refractory nAMD (who previously received at least 12 months of anti-VEGF treatment), evaluated by optical coherence tomography (OCT) in between monthly anti-VEGF injections. The fluid profile on OCT was evaluated before, 1 week after, and 1 month after an intravitreal injection, using central retinal thickness (CRT), manual measurements, and fluid specific volumetric measurements performed by an automated algorithm based on artificial intelligence. Results A significant improvement was found at week 1 in terms of CRT ( p  < 0.0001), intraretinal (IRF) ( p  = 0.007), subretinal fluid (SRF) ( p  < 0.0001), and pigment epithelium detachment (PED) volume ( p  < 0.0001). Volumetric fluid measures revealed a >50% reduction at week 1 for both IRF and SRF for approximately two-thirds of eyes. Poorer short-term response was associated with larger exudative fluid amounts (IRF + SRF) ( p  = 0.003), larger PED ( p  = 0.007), lower visual acuity ( p  = 0.004) and less anatomic changes at treatment initiation ( p  < 0.0001). Univariate and multivariate analysis revealed that visual outcomes 4 and 5 years later was significantly worse with weaker short-term responsiveness ( p  = 0.005), with the presence of atrophy ( p  = 0.01) and larger PED volumes ( p  = 0.002). Conclusions Incomplete responders to anti-VEGF showed a significant short-term response, identifiable at 1 week after injection, with rapid recurrence at 1 month. Weaker short-term responsiveness at 1 week was associated with poorer long term visual prognosis. These patients may need adjuvant treatment to improve their prognosis.