SD‐OCT‐based biomarkers in predicting treatment outcomes of macular oedema secondary to retinal vein occlusion treated with anti‐VEGF therapy

Purpose To investigate the role of spectral domain optical coherence tomography (SD‐OCT)‐based biomarkers in predicting treatment response of macular oedema (MO) secondary to retinal vein occlusion (RVO) to anti‐vascular endothelial growth factor (VEGF) therapy. Methods Retrospective cohort study including consecutive cases of RVO associated MO who received anti‐VEGF injections between January 2020 and April 2021. LogMAR visual acuity (VA) at baseline, 12 and 24 months was correlated with a panel of SD‐OCT‐based biomarkers, including vitreomacular status, size of intra‐retinal cysts (IRC), presence of disorganization of retinal inner layers (DRIL), hyper‐reflective foci (HRF) in the retina, integrity of the external limiting membrane (ELM), ellipsoid zone (EZ), cone outer segment tip (COST) and presence of subretinal fluid (SRF). Results One hundred and thirty eyes were included with 81 and 49 eyes in the BRVO and CRVO subgroup, respectively. In both subgroups, baseline disrupted EZ/ELM [BRVO: ( β = 0.144 p = 0.008; β = 0.111 p = 0.014; β = 0.096 p = 0.042) and CRVO: ( β = 0.316 p < 0.001; β = 0.336 p < 0.001; β = 0.327 p < 0.001)] were associated with worse VA from baseline through 24 months. In the BRVO subgroup, the presence of HRF ( β = 0.209 p < 0.001) correlated with worse baseline VA. Improvement in DRIL extent [OR = 4.355 (1.109–17.094) p = 0.035; OR = 4.510 (1.707–11.917) p = 0.002] and EZ/ELM integrity [OR = 4.474 (1.783–11.223) p = 0.001; OR = 3.214 (1.414–7.305) p = 0.005] were associated with a higher likelihood of achieving at least a 5 letters gain at 12 and 24 months. Conclusion A comprehensive system of SD‐OCT‐based features could predict functional outcomes of MO secondary to RVO with anti‐VEGF therapy up to 24 months.