Baseline PED Correlates with BCVA Change in Treated nAMD Eyes

Credit: Unsplash / alpay tonga

Pigment epithelial detachment volume (PEDV) was negatively correlated with both short- and long-term best corrected visual acuity (BCVA) gains among patients treating their neovascular age-related macular degeneration (nAMD) with an anti-VEGF in a new study.

According to data from an analysis of patient eyes with nAMD, baseline PED provided notable predictive value in interpreting treatment outcomes with conbercept among those without polypoidal choroidal vasculopathy (PCV). Alternatively, patients with nAMD and PCV did not report beneficial predictive value by way of baseline PED.

A team of China investigators, led by Yiyang Shu, of the Department of Ophthalmology at Shanghai General Hospital and Shanghai Jiao Tong University School of Medicine, conducted a study to define the predictive value of quantitative morphological levels of PED among patients with nAMD.

Shu and colleagues conducted qualitative and quantitative analyses of PED including its heigh (PEDH) and width (PEDW), as well as type (PEDT) and PEDV to identify imaging markers for BCVA gains at 3 or 12 months following a conbercept regimen. They then split treated patients further into baseline PCV and non-PCV cohorts to determine the role of the comorbid choroidal disease in PED predictive value.

Historically, PED has served as a valuable prognosticator for poor visual outcomes among patients with nAMD receiving anti-VEGF treatment, investigators wrote.

“Optical coherence tomography (OCT) paired with quantitative analysis, has been widely used for qualitative assessment of different retinal compartments, including intraretinal, subretinal, and subpigment epithelial,” investigators wrote. “For patients with nAMD, such quantitative analysis may reveal functionally relevant microstructural changes not captured by measurements of the retina.”

The team studied 1 eye from each of 159 patients with nAMD. Patients received 0.5 mg conbercept in a 3 plus pro re nata treatment regimen during the trial period. A total of 77 patient eyes (48.4%) had baseline PCV, versus 82 without.

Post-treatment assessments reviewed structure-function correlations per baseline retinal morphologic parameters and BCVA gain at 3 or 12 months. OCT scans assessed retinal morphologic characteristics including PED parameters plus intraretinal cystoid fluid (IRC), subretinal fluid (SRF), and vitreomacular adhesion (VMA).

Patient follow-up was ≥12 months. A majority of patients were male (57.9%); mean BCVA was 48.78 for the PCV cohort and 48.12 for the non-PCV cohort.

BCVA gain from 3 or 12 months post-treatment was negatively correlated with PEDV at baseline among patients without PCV (P = .027). BCVA gain at 12 months was additionally negatively correlated with PEDW at baseline among the same patients (P = .044).

No correlations between PED traits and BCVA gain post-treatment at either 3 or 12 months were observed for patients with PCV (P >.05). Investigators additionally observed no link between baseline SRF, IRC nor VMA and 3- or 12-month BCVA gains among patients with nAMD (P >.05).

“The results confirmed that the PEDV could predict the short- and long-term BCVA gains for non-PCV after intravitreal injection of conbercept,” investigators wrote. “In contrast, quantitative morphological parameters for PED had no predictive effect on the short- and long-term BCVA gains for PCV patients with intravitreal injection of conbercept.”

Investigators concluded their findings “raised some interesting questions” seeing as PED traits were not found to affect BCVA gain. Though the BCVA gain of treated nAMD patients with PCV was less than that of those without PCV, the difference in outcome was not significant.

“Our study follows similar procedures conducted for other anti-VEGF drugs, thus our results may provide reference values for other anti-VEGF drugs as well,” they wrote. “Furthermore, this may have clinical useful implications for predicting the prognosis and monitoring the follow-up of nAMD patients.”

References

1. ^{Shu Y, Ye F, Liu H, Wei J, Sun X. Predictive value of pigment epithelial detachment markers for visual acuity outcomes in neovascular age-related macular degeneration. BMC Ophthalmol. 2023;23(1):83. Published 2023 Mar 3. doi:10.1186/s12886-023-02797-5}