Retrospektive Analyse der intravitrealen operativen Medikamentenapplikation (IVOM). Entwicklung der Sehschärfe mit geringem Ausgangsvisus.

by Sarah Fahimi
Doctoral thesis
Date of Examination:2025-09-17
Date of issue:2025-09-02
Advisor:Prof. Dr. Nicolas Feltgen
Referee:Prof. Dr. Nicolas Feltgen
Referee:PD Dr. Dr. Alexander Meyer
Persistent Address: http://dx.doi.org/10.53846/goediss-11479

 

 

Files in this item

Name:Dissertation_Fahimi_SUB.pdf
Size:2.06Mb
Format:PDF

The following license files are associated with this item:

Abstract

English

Patients with severely reduced best-corrected visual acuity (BCVA) are frequently excluded from intravitreal injection (IVI) therapy due to lower threshold values established in early clinical trials. Since 2006, a BCVA limit—set at 1.3 logMAR —has been widely applied in clinical practice as a criterion for initiating or continuing IVI treatment. However, with the advent of more effective anti-VEGF agents and advances in diagnostic imaging, these historically defined cut-off values may no longer reflect current therapeutic potential. This study aims to reassess the validity of this lower BCVA threshold and evaluate whether patients with very low visual acuity of ≥0.1 logMAR can still benefit functionally and morphologically from IVI therapy. This retrospective, single-center study analyzed 329 treatment-naive patients diagnosed with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or retinal vein occlusion (RVO), all presenting with a baseline BCVA ≥0.1 logMAR. Visual acuity changes were assessed over 6–24 months. Morphological changes were evaluated using SD-OCT images in a defined subgroup with BCVA ≥1.3 logMAR, focusing on structural features based on ORCA criteria. Across all three diagnoses, IVI treatment led to a significant improvement in visual acuity. Mean baseline BCVA of all diseases was 1,3 ± 0.4 logMAR, decreasing to 0.94 ± 0.5 logMAR after 6 months. This gain remained stable throughout the 12-, 18-, and 24-month follow-up periods. Over 30% of all patients reached a BCVA of ≤ 0.2 logMAR within 6 months. Furthermore, 5% of AMD and DME patients and 10% of RVO patients achieved a BCVA of ≤ 0.5 logMAR. The analysis revealed that a high proportion of patients with BCVA ≥1.3 logMAR showed marked morphological improvement—for example, a reduction in intra- and subretinal fluid. Notably, in several cases, structural improvements on OCT were observed without a corresponding gain in visual acuity. Conversely, functional improvements without morphological changes were rare. This study shows that even patients with low visual acuity may benefit from IVI therapy. Functional and especially morphological outcomes suggest that baseline BCVA should not serve as the sole criterion for therapy decisions. A more individualized approach—considering OCT biomarkers and patient needs—is warranted in clinical practice.
Keywords: Low vision; Retinal vein occlusion; Optical coherence tomography; Visual acuity; VEGF Inhibitors; Anti-VEGF therapy; Age-related macular degeneration; Diabetic macular edema
 
Statistik