25578255
OBJECTIVE	Intravitreal antiangiogenic therapy is the major therapeutic breakthrough in neovascular age-related macular degeneration ( AMD ) .
OBJECTIVE	Optical coherence tomography ( OCT ) is the leading diagnostic tool , but solid criteria for optimal therapeutic outcomes are lacking .
OBJECTIVE	A comprehensive analysis of structure/function correlations using Food and Drug Administration - and European Medicines Agency-approved substances and fixed and flexible regimens was performed .
METHODS	Post hoc analysis of a prospective , randomized multicenter clinical trial including 189 study sites .
METHODS	A total of 1240 patients with active neovascular AMD .
METHODS	Participants received intravitreal ranibizumab or aflibercept .
METHODS	A fixed regimen was used for 48 weeks followed by a flexible regimen until week 96 .
METHODS	At monthly intervals , best-corrected visual acuity ( BCVA ) was measured and retinal morphology was assessed by standardized OCT , including intraretinal cysts ( IRCs ) , subretinal fluid ( SRF ) , and pigment epithelial detachment ( PED ) , presenting with a width 400 m or a height of 200 m. Results were correlated for each regimen , feature , and time .
METHODS	The BCVA outcomes in relation to retinal pathomorphology based on noninferiority for all treatment arms .
RESULTS	In neovascular AMD , only IRC at baseline and persistent through week 12 had a negative impact on BCVA .
RESULTS	With therapeutic intervention , exudative features such as IRC and SRF resolved rapidly in 74 % of eyes , whereas PED responded only slowly with 38 % .
RESULTS	Independent of the type of regimen , fixed or flexible , retinal morphology correlated tightly with visual function .
RESULTS	Intraretinal cysts consistently showed the lowest BCVA gains with either regimen or substance .
RESULTS	With the switch from a fixed to a flexible pro re nata ( PRN ) regimen , progressive visual loss occurred exclusively in the group with primary PED presenting as the hallmark of neovascular activity and was induced by secondary formation of IRC in the neurosensory retina .
CONCLUSIONS	The efficacy of antiangiogenic therapy in neovascular AMD is strongly determined by morphologic features .
CONCLUSIONS	The subretinal pigment epithelium lesion underlying PED appears to be the primary indicator for progressive disease activity , whereas secondary cystoid degeneration is the most relevant imaging marker for visual function .
CONCLUSIONS	Clinically , PED emerged as trigger for consecutive vision loss in PRN treatment .

