40.
OCT Guided Anti-VEGF Therapy for Neovascular AMD
Stephan Michels (Zürich)
In the past retreatment decisions for laser treatments in neovascular AMD were commonly
based on fluorescein angiography (FA). Within the last years anti-VEGF therapy has become the
first line therapy for neovascular AMD. Phase III clinical trials using ranibizumab and pegaptanib
have used retreatment regimens independent from CNV activity.
The PrONTO study was the first prospective study on ranibizumab in neovascular AMD to use
an OCT guided retreatment regimen. This regimen allowed reducing the mean number of treatments
over 2 years to 9.9. Despite an increased risk for CNV recurrence at any point in followup
functional and anatomic outcomes were quite promising and comparable to outcomes of
studies using continuous VEGF suppression. At 2 years follow-up mean visual acuity improved
by 10.7 letters and central retinal thickness decreased (CRT) by 215μm.
A prospective study comparing intravitreal bevacizumab to PDT plus intravitreal triamcinolone
for neovascular AMD used an OCT based retreatment regimen for the bevacizumab treatment arm. The mean number of
bevacizumab treatments was 6.8 within one year follow-up. Visual outcomes were significantly better in the bevacizumab
treated group showing an improvement of 8 letters at month 12. Reduction of CRT as measured by OCT was comparable for
both groups.
OCT is the first imaging technology to be used for anti-VEGF retreatment decisions in prospective clinical trials. The recent
development of spectral domain OCTs will further increase the value of this technology for anti-VEGF retreatment decisions.