Impact of Macular Neovascularization Architecture in Age-Related Macular Degeneration on Treatment Requirement During the First 5 Years of Treatment

Background: To investigate baseline MNV characteristics in Optical Coherence Tomography Angiography (OCTA) and its impact on therapeutic needs and visual acuity after 5 years in initially therapy-naïve eyes. Methods: A retrospective study of 43 therapy-naïve eyes with neovascular AMD (nAMD). OCTA was performed at baseline and all eyes were observed for 5 years. MNV architecture was characterized by area, total vessel length, flow density and fractal dimension. These variables were tested for correlation with the number of administered intravitreal injections (IVIs) and best-corrected visual outcome (BCVA) after 5 years of treatment. Results: Mean follow-up time was 4.97 ± 0.21 years. Area and total vessel length of MNVs were significantly associated with a higher number of administered IVIs after 5 years (p < 0.05), flow density significantly correlated with fewer IVIs (p < 0.05). Fractal dimension showed a tendency to more IVIs (p = 0.056) after 5 years. Flow density at baseline correlated with a better BCVA (p < 0.05). In contrast, MNV area size, total vessel length and fractal dimension did not show any correlation to BCVA after 5 years (p > 0.05). Conclusions: Specific features of MNV architecture such as area, total vessel length and flow density can predict long-term treatment requirement and visual outcome. Further studies using deep learning algorithms are necessary to explore the usage of these findings in daily practice.