Optical Coherence Tomography & Optical Coherence Tomography Angiography Biomarkers for Predicting Response to Anti-VEGF Therapy in Neovascular Age-Related Macular Degeneration.

Purpose: To identify optical coherence tomography (OCT) and OCT angiography (OCTA) biomarkers associated with persistent retinal fluid in treatment-naïve neovascular age-related macular degeneration (nAMD) following three loading doses of anti-VEGF therapy.

Methods: In this retrospective study, 60 treatment-naïve typical nAMD patients received three monthly intravitreal bevacizumab injections. Four weeks after the third injection, patients were categorized as responders (Group 1, n = 30) if no fluid was seen, or as suboptimal responders (Group 2, n = 30) if fluid persisted. Baseline OCT and OCTA parameters were assessed, including central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachment (PED) height, hyperreflective foci (HF), subretinal hyperreflective material (SHRM), and macular neovascularization (MNV) morphology. OCTA features were analyzed for loop morphology, branching vessels, peripheral arcades, sea fan pattern, and hypointense halo. Vessel density (VD) was quantified in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC).

Results: No significant differences were found between groups in baseline OCT parameters (all p > 0.05). VD in the SCP, DCP, and choriocapillaris did not differ between groups. However, OCTA revealed that loop morphology (p = 0.001), peripheral arcade (p = 0.009), and branching vessels (p = 0.032) were more frequent in suboptimal responders. On multivariate regression, only loop morphology remained a significant independent predictor of persistent fluid (OR = 4.36, p = 0.036).

Conclusions: Loop-shaped neovascular morphology on baseline OCTA independently predicted poor anatomical response to anti-VEGF therapy. Identifying such features may support early risk stratification and guide personalized treatment strategies.