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The aim of this study was to evaluate influence of baseline imaging features on visual and anatomical outcomes in eyes with PCV treated with anti-VEGF monotherapy. In this prospective study we enrolled participants with treatment-naïve PCV who followed a treat-and-extend protocol using intravitreal aflibercept (IVA) monotherapy. Baseline clinical features evaluatedincluded best corrected visual acuity (BCVA), traditional features such as lesion size, fluid-related OCT parameters and novel parameters using automated software. This included quantitative and qualitative pigment epithelium detachment (PED) parameters [height, volume]; and choroidal parameters. [choroidal thickness (CT), choroidal volume (CV) and choroidal vascularity index (CVI). We evaluated the predictive value of each parameter on visual and anatomical outcome at month 12. We additionally evaluated initial treatment response after 3 monthly injections with respect to month 12 outcomes. Fifty-two eyes from 52 participants were included in the study. The BCVA increased from 61.1 ± 13.2 to 69.6 ± 13.2 early treatment diabetic retinopathy study (ETDRS) letters ( p  &lt; 0.01) and CRT reduced from 455.7 ± 182.4 µm to 272.7 ± 86.2 ( p  &lt; 0.01) from baseline to month 12. The proportion of eyes with PED decreased significant from 100% at baseline to 80% at month 12 ( p  &lt; 0.01). Reduction in the mean maximum height of PED (from 381.3 ± 236.3 µm to 206.8 vs ± 146.4 µm) and PED volume (from 1322 ± 853 nl to 686 ± 593 nl) ( p  &lt; 0.01) was also noted from baseline to month12. Baseline features associated with better month 12 BCVA included baseline BCVA (β =  − 0.98, 95%CI − 3.38 to − 1.61,  p  = 0.02) and baseline CRT (β =  − 0.98, 95%CI − 1.56 to − 0.40,  p  = 0.04) while the disease activity at month12 was significantly associated with lower baseline CRT (366.0 ± 129.5 vs 612.0 ± 188.0 ,  p  &lt; 0.001), lower baseline PED height (242.0 ± 150.0 vs 542.0 ± 298.0 µm,  p  &lt; 0.01), lower baseline PED volume (0.6 ± 0.3 mm 3  vs 2.2 ± 1.3 mm 3  vs,  p  &lt; 0.01), lower proportion with marked CVH (17.9% vs 46.2%,  p  = 0.02) and lower mean CVI (61.8 ± 1.4 vs 63.0 ± 1.4,  p  &lt; 0.02). Additionally, a larger decrease in CRT (per 100 nm) and larger PED volume reduction (per 100 nl) at month 3 from baseline were associated with greater BCVA gain and inactive disease. PED-related volumetric parameters have an additional predictive value to traditional biomarkers of disease activity in eyes with PCV undergoing anti-VEGF monotherapy. With increasingly precise quantification, PEDs can be a crucial biomarker in addition to traditional parameters and may aid in retreatment decisions.

Novel volumetric imaging biomarkers for assessing disease activity in eyes with PCV