Optical Coherence Tomography Pattern of Fluid Recurrence in AMD Patients Treated With Ranibizumab

Purpose:To evaluate OCT patterns of retinal fluid presenting as sign of leakage recurrence following 3 injection of ranibizumab in patients with AMD Methods:23 eyes of 23 patients (15 female, 8 male, mean age 75 years, 5 predominantly classic, 3 minimally classic and 15 occult NVM) received 3 consecutive monthly intravitreal injection of ranibizumab (0.5 mg).In the case of visual acuity (VA) loss of at least 5 letters with OCT evidence of retinal fluid or fluorescein angiography (FA) evidence of leakage patients were reinjected. Patients underwent ETDRS VA, FA and OCT (Spectralis, Heidelberg) examination at baseline and at monthly interval for 6 months. Four patterns of retinal fluid were investigated: diffuse retinal edema (DE), subretinal fluid (SRF), intraretinal cysts (RC) and sub-RPE fluid (SRPF). Horizontal and vertical scans at the fovea and in correspondence of FA leakage, star-shaped and volume scans were acquired by means of OCT. Results:At baseline 18 eyes showed RC, 15 DE, 17 SRF and 19 eye SRPF. At month 3 (one month post third injection) only 4 eyes showed residual RC and SRF, but stable VA, that declined at month 4 (1 eye, 4.3%) and month 5 (3 eyes, 13%) and were reinjected. At month 4 three eyes (13%) showed SR and three (13%) SR and RC or DE, at month 5 five eyes (21.7%) showed SR fluid and three (13.9%) SRF and RC and at months 6 five eyes (21.7%) showed SRF and DE or RC and two (8.6%) SRF. At month 6 two eyes (8.4%) with SR fluid at month 3 and one (4.3%) with SR at month 5 showed an increase of SR and developed DE and RC and A VA decrease > 5 letters and needed a retreatment. SRPF decreased in all 19 eyes, but disappeared in only 10.At 6 months 15 eyes (75.1%) showed a fluid-free retina and in total 10 eyes (43.4% ) were reinjected during follow up. In 5 eyes (21.7%) During follow up SRF recurrence were detected before at CNV boundaries and subsequently fluid increased at boundaries and in macular region causing VA decrease. Conclusions:Subretinal fluid at the CNV boundaries was the early and sole sign of recurrent retinal fluid in 21.7%. Interesting small SR fluid appearance showing subtle disease activity was detectable at the outer edge of 21.7% CNVM and temporally preceding macular RC and DE appearance. This early sign of recurrence could be a novel sign to value disease progression and reinjection decision.