Image markers as predictors of response in neovascular agerelated macular degeneration treated with ranibizumab.

Abstract

Objective: To identify features in enhanced depth imaging spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and fundus auto fluorescence (FAF) of patients with neovascular age-related macular degeneration (nAMD), as image markers of poor response to intravitreal Ranibizumab therapy. Methods: Descriptive, comparative, cross sectional study. We evaluated the clinical charts of patients with nAMD on intravitreal Ranibizumab therapy. Subjects were divided into 2 groups: those with good response to Ranibizumab (G1) and those with poor response to therapy (G2). All patients underwent wide field fundus FA, wide field FAF and SD-OCT. Absolute and relative frequencies, strength of association (chi2) and prevalence ratio, with a 95% significance level were calculated. Results: The analysis included 30 eyes, 15 eyes in G1 and 15 eyes in G2. We found a statistically significant correlation between poor responders and the presence of external tubulations (p = 0.03). In the good responder group there was significant correlation with the presence of sub retinal fluid (p = 0.04), absence of sub retinal thickening (p < 0.01), absence of fibrosis at the FA (p = 0.02) and presence of hyper-auto fluorescent findings on the FAF (p ≤ 0.01). Conclusion: The identification of image markers prior to treatment could help predict the response to ranibizumab therapy in nAMD patients. The presence of sub retinal fluid, absence of sub retinal thickening, absence of fibrosis and presence of hyper-auto fluorescent were associated with good responder. These markers, plus initial visual acuity can be used as a guide for categorization of patients according to response expectation, and therefore tailor the follow up scheme.