Fluorescein angiographic characteristic in predominantly classic and occult types of neovascular age-related macular degeneration treated with ranibizumab

Abstract

Background and purpose: Randomised-controlled clinical trials (the ANCHOR and MARINA) examined the intravitreal anti-vascular endothelial growth factor (anti-VEGF) efficacy for eyes having fluorescein angiographic classic and occult (OCC) neovascular lesions. No significant difference in the treatment response between the lesion types was observed. Fundus fluorescein angiography and optical coherence tomography (OCT) are complementary devices that provide information about neovascular age-related macular degeneration (n-AMD). The aim of this retrospective study was to compare the clinical aspects of fluorescein angiographic characteristics in predominantly classic (PDC) and OCC subtypes of n-AMD treated with intravitreal ranibizumab.

Methods: Treatment-naive fluorescein angiographic OCC-n-AMD and PDC-n-AMD patients, who received monthly intravitreal ranibizumab for 3 months after baseline, and were followed-up with pro re nata injections between March 2013 and February 2018, were included. Means of the visual acuity (VA), central macular thickness (CMT), and intravitreal injection and visit numbers of the groups were compared throughout 24 months.

Results: We included 41 eyes of PDC-n-AMD patients and 36 eyes of OCC-n-AMD patients. The mean ages were 74.5 ± 10.6 and 71.9 ± 9.4, respectively. The baseline, and 3-, 6-, 12-, 18-, and 24-month VA results of the OCC group were significantly better than those in the PDC. However, VA gain in the PDC group at 3, 6, and 12 months was significantly higher than that in the OCC group. The mean of baseline CMT of the PDC (353 ± 118 µm) was significantly higher than that in the OCC group (293 ± 64 µm). No significant differences in terms of the number of visits or injections, or CMT change from the baseline values between groups were observed.

Conclusion: The OCC-n-AMD patients had better baseline and follow-up VA and CMT means than the PDC-n-AMD patients. However, the PDC-n-AMD patients are expected to benefit more than the OCC-n-AMD patients in terms of VA gains.

Keywords: age-related macular degeneration; classical; fluorescein angiography; neovascular; occult; ranibizumab.

Figure 1.

A descriptive scheme summarising the study design.

Figure 2.

Representative images of the fluorescein angiographic PDC and OCC n-AMDs, respectively. (a–d) Colour, and early, mid, and late phase representatives for the fundus fluorescein angiography of the PDC types, respectively. (e–h) Colour, and early, mid, and late phase representatives of the fundus fluorescein angiography of the OCC types, respectively.

Figure 3.

(a) Diagram of the VA (ETDRS letters) of the PDC and OCC types of n-AMD after receiving anti-VEGF treatment throughout the 24 months. (b) Diagram of CMT of the PDC and OCC types of n-AMD after receiving anti-VEGF treatment throughout the 24 months.

Figure 4.

Spectral-domain OCT scans and VA (ETDRS letters) changes throughout the 24 months in the PDC and OCC n-AMD patients, which were presented in Figure 2. (a–f) Baseline, and 3-, 6-, 12-, 18-, and 24-month macular OCT and VA values of the PDC n-AMD patients. (g–l) Baseline, and 3-, 6-, 12-, 18-, and 24-month macular OCT and VA values of the OCC n-AMD patients.

Figure 5.

(a) Mean number of injections in the PDC and OCC n-AMD groups at 3, 6, 12, 18 and 24 months, respectively. (b) Mean total number of visits in the PDC and OCC n-AMD groups at 3, 6, 12, 18 and 24 months, respectively.