Evaluating the risk of recurrence in neovascular age-related macular degeneration using OCT-angiography at the time of treatment exit.

Background/aims To find biomarkers on OCT-angiography (OCT-A) that indicate a higher risk of recurrence in neovascular age-related macular degeneration (nAMD) patients before anti-vascular endothelial growth factor (anti-VEGF) therapy termination. Methods Retrospective, observational study. Stable, inactive nAMD patients who had been treated with a treat-and-extend regimen and met the predefined exit criteria were included. The macular neovascularisation (MNV) lesion was imaged on OCT-A. Lesion area, vessel density (VD), fractal dimension and height of feeder vessel were quantified. Patients with disease recurrence after termination were compared with those who stayed inactive. Results Out of 819 eyes diagnosed with nAMD and 281 with a 2-year follow-up, 77 (27.4%) reached the exit criteria. Thirty-four eyes of 33 (15 female) patients with reliable OCT-A were further analysed. Mean age was 80.35 (±9.29) years, the number of injections was 16.68 (±8.22). Treatment duration before exit was 36.15 (±16.63) months. After exit, 23 eyes stayed inactive for a follow-up period of 23.00 (±16.18) months, and 11 experienced recurrence after 13.36 (±9.90) months. VD was significantly higher in the recurrent versus inactive group with 0.60 (±0.15) versus 0.47 (±0.11), p=0.015. There was an insignificant tendency for the protective properties of type 1 MNV and a low feeder vessel. Conclusion OCT-A is useful in the risk calculation for recurrence in patients who are about to discontinue anti-VEGF treatments in nAMD. Patients with a high VD might need closer follow-ups or continued anti-VEGF treatments even if inactive.