title: Intraretinal cysts are the most relevant prognostic biomarker in neovascular age-related macular degeneration independent of the therapeutic strategy.
abstract: OBJECTIVE
  To investigate the impact of antiangiogenic monotherapy and photodynamic therapy (PDT) as add-on strategy on retinal morphology, and to analyse prognostic biomarkers for visual outcome and retreatment frequency in neovascular age-related macular degeneration (nAMD).
  
  
  METHODS
  255 patients participating in the MONT BLANC study were evaluated. Patients were randomised to receive as-needed ranibizumab monotherapy or combination therapy (verteporfin PDT and ranibizumab). Outcome measures included visual acuity (VA), retinal morphology assessed by optical coherence tomography and retreatment frequency.
  
  
  RESULTS
  The proportion of scans showing intraretinal cysts (IRC) or subretinal fluid (SRF) decreased more intensively in the combination than in the monotherapy group. Pigment epithelial detachments (PED) decreased significantly only in the combination group. Patients with IRC presented the lowest initial VA, and IRC had the strongest negative predictive value for functional improvement in both groups. SRF showed a predictive value for a higher number of ranibizumab injections (combination, +0.9; monotherapy, +0.8) and a higher number of PDT treatments in the combination group (+0.3). PED was associated with a higher number of ranibizumab injections only in the monotherapy group (+1.2).
  
  
  CONCLUSIONS
  Combination and monotherapy showed a distinct response pattern for morphological parameters in nAMD. IRC was the only relevant prognostic parameter for functional outcome.
  
  
  BACKGROUND
  NCT00433017.
authors: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors: Markus
authors: M
authors: Ritter
authors: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors: Christian
authors: C
authors: Simader
authors: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors: Matthias
authors: M
authors: Bolz
authors: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors: Gábor G
authors: GG
authors: Deák
authors: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors: Ulrike
authors: U
authors: Mayr-Sponer
authors: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors: Ramzi
authors: R
authors: Sayegh
authors: Center for Public Health, Institute of Environmental Health, Medical University of Vienna, Vienna, Austria.
authors: Michael
authors: M
authors: Kundi
authors: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors: Ursula M
authors: UM
authors: Schmidt-Erfurth
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D015415:Biomarkers; D003131:Combined Modality Therapy; D003560:Cysts / Q000473:pathology*; D004311:Double-Blind Method; D006801:Humans; D058449:Intravitreal Injections; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011166:Porphyrins / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D000069579:Ranibizumab; D012160:Retina / Q000473:pathology; D012164:Retinal Diseases / Q000473:pathology*; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D000077362:Verteporfin; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D015415:Biomarkers; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D000069579:Ranibizumab
keywords: Degeneration; Imaging; Macula; Neovascularisation; Treatment Medical