nPredictability of Recalcitrance in Neovascular Age-Related Macular Degeneration With Indocyanine Green Angiography

Purpose: This study aimed to evaluate the utility of indocyanine green (ICG) angiography in predicting recalcitrance in neovascular age-related macular degeneration (nAMD). Design: A retrospective case series. Methods: The charts of treatment-naive subjects with nAMD undergoing antiYvascular endothelial growth factor (anti-VEGF) therapy during a 6-month period were retrospectively reviewed. The study group consisted of subjects with persistent retinal edema on optical coherence tomography (OCT) despite 6 consecutive monthly anti-VEGF injections. The control group was age-matched to the study group and consisted of subjects who demonstrated complete resolution of retinal edema on OCT after 3 or fewer monthly anti-VEGF injections. Results: There were 42 study cases and 42 controls included in the analysis. The baseline visual acuity, central macular thickness on OCT, and choroidal neovascularization (CNV) surface area on ICG angiography were statistically similar between the study and control groups. The CNV surface area on ICG angiography 2 months after starting consecutive monthly anti-VEGF injections increased from a baseline of 1.78 +/- 0.86 to 2.66 +/- 0.92 mm(2) in the study group (P = 0.008) and decreased from a baseline of 1.94 +/- 0.97 to 1.12 +/- 0.05 mm2 in the control group (P = 0.04); this change in CNV size on ICG angiography from baseline to 2-month follow-up was statistically significant between the study and control groups (P < 0.0001). Conclusions: Change in CNV surface area on ICG angiography can predict which subjects with nAMD are likely to have persistent retinal edema on OCTafter 6 or more consecutive monthly anti-VEGF injections.