OCT-based morphological prognostic factors for structural improvement after anti-VEGF therapy in wet age-related macular degeneration

To investigate the relationship between baseline optical coherence tomography (OCT) features of wet age-related macular degeneration (wAMD) and prognosis, and evaluate anti-VEGF treatment effects under varying baseline OCT conditions. This retrospective study included patients diagnosed with wAMD who underwent monthly anti-VEGF therapy for 1–3 months. Baseline, one-month, and three-month OCTs recorded morphological features. Treatment effectiveness was defined as central retinal thickness (CRT) reduction ≥ 25%, or absence of subretinal fluid (SRF) and intraretinal fluids (IRF) post-treatment. Data from 251 eyes were analyzed. After one injection, effective responders had smaller baseline lesion sizes (11.01 ± 9.93 vs. 12.53 ± 8.80, P = 0.046), lower PED height (124.10 ± 232.55 vs. 216.06 ± 248.66, P < 0.001), and larger baseline IRF (86.52 ± 154.74 vs. 31.26 ± 81.14, P = 0.002) compared to non-responders. After three injections, effective responders continued to show larger baseline IRF (65.94 ± 135.20 vs. 20.28 ± 61.93, P = 0.015). Multivariate analysis indicated greater CRT reductions at one and three months were associated with larger baseline CRT (P < 0.001), larger baseline IRF (P < 0.001 and P = 0.012), and absence of retinal hemorrhage (P = 0.003). Baseline OCT features significantly influence treatment responsiveness in wAMD. Tailoring anti-VEGF regimens based on these features may improve outcomes.