Linking disease activity with optical coherence tomography angiography in neovascular age related macular degeneration using artificial intelligence.

To investigate quantitative associations between AI-assessed disease activity and optical coherence tomography angiography (OCTA)-derived parameters in patients with neovascular age-related macular degeneration (nAMD) undergoing anti-VEGF therapy. OCTA and SD-OCT images obtained from multicenter, randomized study data were evaluated. A deep learning algorithm (RetInSight) was used to detect and quantify macular fluid on SD-OCT. Mixed effects models were applied to evaluate correlations between fluid volumes, macular neovascularization (MNV)-type and OCTA-derived MNV parameters; lesion size (LS) and vessel area (NVA). 230 patients were included. A significant positive correlation was observed between SRF and NVA (estimate = 199.8 nl/mm2, p = 0.023), while a non-significant but negative correlation was found between SRF and LS (estimate = - 71.3 nl/mm2, p = 0.126). The presence of Type I and Type II MNV was associated with significantly less intraretinal fluid (IRF) compared to Type III MNV (estimate type I:- 52.1 nl, p = 0.019; estimate type II:- 51.7 nl, p = 0.021). A significant correlation was observed between pigment epithelial detachment (PED) and the interaction between NVA and LS (estimate:28.97 nl/mm2; p = 0.012). Residual IRF at week 12 significantly correlated to baseline NVA (estimate:38.1 nl/mm2; p = 0.015) and LS (estimate:- 22.6 nl/mm2; p = 0.012). Fluid in different compartments demonstrated disparate associations with MNV OCTA features. While IRF at baseline was most pronounced in type III MNV, residual IRF was driven by neovascular MNV characteristics. Greater NVA in proportion to LS was associated with higher amounts of SRF and PED. The correlation between these parameters may represent MNV maturation and can be used as a biomarker for resolution of disease activity. AI-based OCT analysis allows for a deeper understanding of neovascular disease in AMD and the potential to adjust therapeutic strategies to optimize outcomes through precision medicine.

Schranz M ，Bogunovic H ，Deak G ，Sadeghipour A ，Reiter GS ，Schmidt-Erfurth U ... -  《Scientific Reports》

Outcomes and predictive factors for fluid resolution following three loading injections of faricimab for treatment-naïve neovascular age-related macular degeneration.

To evaluate the outcomes and predictive factors for fluid resolution following three loading injections of faricimab for neovascular age-related macular degeneration(AMD). This retrospective study included patients diagnosed with treatment-naïve neovascular AMD who received three monthly injections of faricimab. Changes in best-corrected visual acuity(BCVA) and central retinal thickness(CRT) following treatment were evaluated. The resolution of subretinal fluid(SRF), intraretinal fluid(IRF), and serous pigment epithelial detachment(PED) was also assessed. In addition, factors associated with complete resolution of SRF and IRF were investigated. A total of 69 patients were included in this study. BCVA significantly improved from a mean logarithm of minimal angle of resolution of 0.64 ± 0.41 at baseline to 0.47 ± 0.39 at 3 months (P < 0.001). CRT significantly decreased from 424.1 ± 155.5 μm at baseline to 266.3 ± 71.7 μm at 3 months (P < 0.001). At baseline, SRF was observed in 55 eyes (79.7%), IRF in 39 eyes(56.5%), and serous PED in 57 eyes(82.6%). By 3 months, the number of eyes showing these findings had decreased to 11 eyes(15.9%) for SRF, 6 eyes(8.7%) for IRF, and 10 eyes(14.5%) for serous PED. The presence of type 2 (88.2%) and type 3 (94.7%) macular neovascularization(MNV) was associated with a high incidence of complete resolution of SRF and IRF after treatment. Three loading injections of faricimab resulted in significant functional and anatomical improvements in treatment-naïve neovascular AMD, with a high rate of resolution of SRF, IRF, and serous PED. The anatomical effects were especially pronounced in cases of type 2 and type 3 MNV.

Han HY ，Park SM ，Lee JH ，Kim CG ，Kim JW ，Cho HJ ，Kim JH ... -  《Scientific Reports》

Topographical Quantification of Retinal Fluid in Type 3 MNV and Associations With Short-Term Visual Outcomes.

This study aims to quantify the volume of intraretinal fluid (IRF), subretinal fluid (SRF), and subretinal pigment epithelium (sub-RPE) fluid in treatment-naïve Type 3 macular neovascularization (MNV) eyes with age-related macular degeneration (AMD) and to investigate the correlation of these fluid volumes with visual acuity (VA) outcomes at baseline and following antivascular endothelial growth factor (VEGF) treatment. Retrospective, clinical cohort study. In this study, we analyzed patients diagnosed with exudative AMD and treatment-naïve Type 3 MNV undergoing a loading dose of anti-VEGF therapy. Using a validated deep-learning segmentation strategy, we processed optical coherence tomography (OCT) B-scans to segment and quantify IRF (i.e., both in the inner and outer retina), SRF, and sub-RPE fluid volumes at baseline. The study correlated baseline fluid volumes with baseline and short-term VA outcomes postloading dose of anti-VEGF injections. Forty-six eyes from 46 patients were included in this study. Visual acuity was 0.51 ± 0.30 LogMAR at baseline and 0.33 ± 0.20 LogMAR after the loading dose of anti-VEGF (P = .001). Visual acuity at the follow-up visit was 0.40 ± 0.17 LogMAR in patients with no complete resolution of retinal fluid and 0.31 ± 0.20 LogMAR in eyes without retinal fluid after treatment (P = .225). In the multivariable analysis, the IRF volume in the inner retina (P = .032) and the distance of the MNV from the fovea (P = .037) were predictors of visual acuity at baseline. The baseline IRF volume in the inner retina also predicted the visual acuity at follow-up (P = .023). The present study highlights the fluid volume in the inner retina as a crucial predictor of short-term visual outcomes in Type 3 MNV, underscoring the detrimental effect of IRF on neuroretinal structures.

Berni A ，Oakley JD ，Dolz-Marco R ，Gallego-Pinazo R ，Cimorosi F ，Ghilardi A ，Russakoff DB ，Barresi C ，Introini U ，Reibaldi M ，Bandello F ，Borrelli E ... -  《-》

Long-term effect of fluid volumes during the maintenance phase in neovascular age-related macular degeneration: results from Fight Retinal Blindness!

To investigate the effect of macular fluid volumes (subretinal fluid [SRF], intraretinal fluid [IRF], and pigment epithelium detachment [PED]) after initial treatment on functional and structural outcomes in neovascular age-related macular degeneration in a real-world cohort from Fight Retinal Blindness! Treatment-naive neovascular age-related macular degeneration patients from Fight Retinal Blindness! (Zürich, Switzerland) were included. Macular fluid on optical coherence tomography was automatically quantified using an approved artificial intelligence algorithm. Follow-up of macular fluid, number of anti-vascular endothelial growth factor treatments, effect of fluid volumes after initial treatment (high, top 25%; low, bottom 75%) on best-corrected visual acuity, and development of macular atrophy and fibrosis was investigated over 48 months. A total of 209 eyes (mean age, 78.3 years) were included. Patients with high IRF volumes after initial treatment differed by -2.6 (p = 0.021) and -7.4 letters (p = 0.007) at months 12 and 48, respectively. Eyes with high IRF received significantly more treatments (+1.6 [p < 0.001] and +5.3 [p = 0.002] at months 12 and 48, respectively). Patients with high SRF or PED had comparable best-corrected visual acuity outcomes but received significantly more treatments for SRF (+2.4 [p < 0.001] and +11.4 [p < 0.001] at months 12 and 48, respectively) and PED (+1.2 [p = 0.001] and +7.8 [p < 0.001] at months 12 and 48, respectively). Patients with high macular fluid after initial treatment are at risk of losing vision that may not be compensable with higher treatment frequency for IRF. Higher treatment frequency for SRF and PED may result in comparable treatment outcomes. Quantification of macular fluid in all compartments is essential to detect eyes at risk of aggressive disease.

Reiter GS ，Mares V ，Leingang O ，Fuchs P ，Bogunovic H ，Barthelmes D ，Schmidt-Erfurth U ... -  《-》

Erratum: Eyestalk Ablation to Increase Ovarian Maturation in Mud Crabs.

《Jove-Journal of Visualized Experiments》