Anatomical measures as predictors of visual outcomes in ranibizumab-treated eyes with neovascular age-related macular degeneration.

PURPOSE To investigate if anatomical characteristics of eyes undergoing ranibizumab therapy were predictive of best-corrected visual acuity (BCVA) outcomes over 2 years. METHODS Post hoc analyses of patients with age-related macular degeneration from PIER studies, defined by fundus fluorescein angiography, quantitative optical coherence tomography (OCT), and qualitative OCT, were performed to determine if associations with BCVA outcomes could be found. RESULTS Ranibizumab-treated subgroups defined by baseline fundus fluorescein angiography lesion size and composition did not differ in BCVA outcomes at month 24 (P = 0.13-1.0). Inactivity on fundus fluorescein angiography at month 3 was associated with a 12-letter gain by month 12 (P < 0.01), whereas inactivity on month 3 qualitative OCT was not (P > 0.05). Qualitative OCT inactivity at month 5 and separately at month 8 was associated with greater BCVA gains by month 24 (7.1 and 9.5 letters, respectively; P ≤ 0.045) versus eyes with OCT activity. CONCLUSION When assessed separately, eyes with qualitative OCT (Months 5 and 8) or fundus fluorescein angiography (months 3 and 5) inactivity maintained vision gain from baseline at month 24, while those with leakage not only lost initial vision gains achieved by intraocular ranibizumab but also had net vision losses from baseline at month 24. The PIER infrequent dosing regimen likely exaggerated and accelerated the deleterious effects of retinal fluid on BCVA, and it is not known whether these findings are applicable to treatment regimens that use more frequent monitoring and dosing of ranibizumab.