Baseline Optical Coherence Tomography Biomarkers Associated with the 2-Year Development of Macular Atrophy or Fibrosis in Neovascular Age-related Macular Degeneration

Purpose: To evaluate baseline structural OCT biomarkers associated with the development of macular atrophy or fibrosis in treatment-naïve eyes with exudative neovascular age-related macular degeneration (AMD) managed with a treat-and-extend (T&E) anti-VEGF regimen. Design: A retrospective, cohort study. Participants: Eighty-nine eyes of 89 patients with newly diagnosed exudative neovascular AMD, treated with a T&E regimen and followed for 24 months. Eyes with evidence of macular atrophy or fibrosis at baseline were excluded. Methods: Structural OCT scans were assessed at baseline for morphological features including, macular neovascularization (MNV) subtype and presence of subretinal fluid, intraretinal fluid (IRF), subretinal hyperreflective material, hyperreflective foci, and subretinal drusenoid deposits. Two masked graders independently evaluated each scan, with adjudication for discrepancies. Cox regression models were used to determine baseline predictors of macular atrophy and fibrosis over 24 months. Main Outcome Measures: Development of macular atrophy or fibrosis during 24 months, expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). Results: During follow-up, 28 eyes (31.5%) developed macular atrophy and 12 eyes (13.5%) developed macular fibrosis, with 10 eyes showing both complications. Multivariate Cox regression identified baseline IRF (HR, 6.07; 95% CI, 2.23-16.48) and type 3 MNV (HR, 4.38; 95% CI, 1.63-11.73) as independent predictors of macular atrophy, whereas type 1 MNV was protective (HR, 0.23; 95% CI, 0.09-0.61). Type 2 MNV emerged as the strongest predictor of macular fibrosis (HR, 7.28; 95% CI, 1.51-35.10). Conclusions: Baseline OCT biomarkers, particularly IRF and type 3 MNV, strongly predict macular atrophy, while type 2 MNV predicts fibrosis in eyes with exudative neovascular AMD treated with a T&E regimen. Type 1 MNV may confer protection against atrophy. These exploratory findings underscore the value of comprehensive baseline OCT assessment for anticipating long-term structural outcomes and guiding clinical management. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.