Characteristics of age-related macular degeneration showing a poor response to three loading doses of anti-VEGF

To analyze the clinical features of refractory age-related macular degeneration (AMD) patients associated with the response to three consecutive loading doses of anti-vascular endothelial growth factor (VEGF).A retrospective chart review was performed on typical exudative AMD patients treated by three consecutive anti-VEGF injections. The patients were divided into a group without residual fluid on optical coherence tomography (OCT) images (Group 1) and a group with residual fluid (Group 2). We analyzed qualitative and quantitative morphological features of OCT and OCT angiography (OCTA). We performed univariate and multivariate logistic regression analyses to identify factors associated with the treatment response.We enrolled a total of 90 patients (Group 1: n = 60 , Group 2: n = 30). Under OCT, the choroidal thickness (CT) differed significantly between groups 1 and 2 (246.60 ± 67.67 vs. 286.90 ± 40.92 µm, p = 0.001). Under OCTA, The presence of branching (48.3% vs. 73.3%, p = 0.024), loops (31.7% vs. 66.7%, p = 0.002) and a peripheral arcade (40.0% vs. 76.7%, p = 0.001) differed significantly. Logistic regression analysis showed that the initial CT (B = 0.012; p = 0.007), presence of loops (B = 1.289; p = 0.015) and peripheral arcade (B = 1.483; p = 0.008) significantly affected the anti-VEGF treatment response.A thicker choroid and the presence of loops and a peripheral arcade were significantly associated with a poorer response to three loading anti-VEGF injections in typical exudative AMD patients.