Clinical Characteristics of Patients with Neovascular Age-Related Macular Degeneration and Responses to Anti-VEGF Therapy: Four-Group Stratification Based on Drusen and Punctate Hyperfluorescence.

Background/

Objectives

Different disease subtypes in neovascular age-related macular degeneration (nAMD) influence treatment burden, yet existing classifications such as the pachychoroid neovasculopathy (PNV)/non-PNV dichotomy may not fully capture clinical heterogeneity. This study aimed to compare the 12-month outcomes of intravitreal aflibercept (IVA) in treatment-naïve patients with unilateral nAMD stratified by the presence or absence of drusen and punctate hyperfluorescence (PH).

Methods

This retrospective study included 130 eyes of 130 patients categorized into the Drusen-/PH-, Drusen+/PH-, Drusen-/PH+, and Drusen+/PH+ groups. Their best-corrected visual acuity, retinal thickness, choroidal thickness, number of injections, no-retinal fluid rate during the loading dose regimen, and 12-month retreatment rate following treatment initiation were determined. The primary outcome was 12-month retreatment rate for the four groups, which was determined using Kaplan-Meier curves and log-rank tests. Exploratory metric multidimensional scaling (MDS) was used to visualize the baseline profiles.

Results

The 12-month retreatment rates of the groups were significantly different. The Drusen+/PH- group had a higher retreatment rate and required more injections than the Drusen-/PH+ and Drusen+/PH+ groups. The Drusen+/PH- group was older than the Drusen-/PH+ and Drusen-/PH- groups. The Drusen-/PH+ group had a thicker choroid than the Drusen+/PH- group. The MDS results clear separation of the groups, consistent with the older age of the Drusen+/PH- group and the thicker choroid of the Drusen-/PH+ group.

Conclusions

nAMD stratified based on drusen and PH differed in age, choroidal thickness, and IVA outcomes. The four-category framework provides greater pathophysiologic and therapeutic resolution than the simple PNV/non-PNV dichotomy and may help anticipate injection demand to guide individualized dosing strategies.