Retinal pigment epithelium elevation values as a marker in determining the anatomical prognosis and treatment regimen of type 2 macular neovascularization

Abstract

Abstract Objective To determine the prognostic value of the RPE elevation area or volume and the other morphological OCT biomarkers in nAMD cases. Methods Fifty-one eyes of 51 naive patients with nAMD were included. The treat-and-extend regimen was used. A total of 3 intravitreal doses of bevacizumab (IVB) were administered (loading phase). After the loading phase, two groups were divided according to the presence of IRF/SRF and the absence of IRF/SRF. Three doses of intravitreal aflibercept were loaded in eyes with refractory or recurrent fluid. OCT was used to evaluate central retinal thickness, morphological characteristics, center 3 and 5 mm RPE elevation area and volume. Results After the IVB loading, 27 of 51 patients had IRF/SRF, while 24 did not. When the BCVA change in the 3rd, 6th and 12th months was compared between the groups according to the presence of SHRM, the gain was higher in the non-SHRM group. The absence of a sub-RPE hyperreflective column was found to be a risk factor for fluid resistance after IVB loading. Central 3 mm RPE elevation area and volume were different between the two groups. It was observed that while the baseline RPE-3mm-area and baseline RPE-3mm-volume values were incerasing, the risk of fluid resistance after IVB loading was significantly increased. Conclusion The RPE elevation area at the central 3 mm at the first presentation may have value as a marker in determining the prognosis of nAMD, and may be considered as an indicator for which treatment regimen can be chosen initially.