Response of Pigment Epithelial Detachment to Three-Loading-Dose of Intravitreal Anti-Vascular Endothelial Growth Factor in Neovascular Age-Related Macular Degeneration

Objective: Response of pigment epithelial detachment (PED) to three loading dose of intravitreal bevacizumab (IVB) treatment in neovascular age-related macular degeneration (nAMD) cases. Methods: OCT findings (PED height (µm), diameter(µm) and area (mm²), central macular thickness (CMT), central choroidal thickness (CCT), intraretinal fluid (IRF), subretinal fluid (SRF)), and morphological features of macular neovascularization (MNV) in OCTA before and after three loading doses of IVB were examined and compared. Results: Forty-two eyes of 42 naive nAMD patients with PED were included. Fifteen patients had serous and 27 patients had fibrovascular PED. After three loading doses, best corrected visual acuity (BCVA) (in Snellen) increased from 0.22±0.19 to 0.29±0.22 (p<0.001). The mean PED height, width and area decreased (323.46±189.80 µm,274.79±199.80 µm, p=0.007; 1639.87±1037.44 µm, 1599.01±993.88 µm, p=0.138; 2.90±2.76 mm², 2.24±2.38 mm², p=0.038 respectively). CMT decreased from 500.34±286.62 µm to 366.14±238.10 µm, CCT decreased from 251.55±74.44 µm to 197.09±50.36 (p<0.001 for both). IRF or SRF were significantly regressed (p=0.008 and p=0.032). Branching decreased from 23.8% of patients to 11.9% (p=0.044), loops completely regressed (p<0.001), hypointense halo decreased from 7.1% of patients to 4.6% (p=0.323), open circulation decreased from 23.8% to 4.6% (p<0.001). Seafan and medusa NV were present in 2.3% and 4.6% of patients, however did not differ. The pruned tree NV increased from 11.9% to 33.3% (p<0.001). Closed circulation increased from 33.3% to 38% (p=0.083). Discussion: After three loading doses of IVB, PED height and area were significantly reduced and also 21.4% of PED completely regressed and 52.3% of PED decreased. MNV with PED, particularly brancing, loops had regressed, and most of the pruned tree formations were increased and some of the open circulations were converted to closed circulation. In conclusion, 3 loading doses IVB decreased the size a half of PEDs and changed feature of MNVs with PED.