LONG-TERM OUTCOMES OF BACILLARY LAYER DETACHMENT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

PURPOSE To evaluate the clinical characteristics, multimodal imaging features, and long-term treatment outcomes of eyes with neovascular age-related macular degeneration (nAMD) and bacillary layer detachment (BALAD) treated with intravitreal anti-vascular endothelial growth factor (VEGF) therapy. DESIGN Retrospective, longitudinal, case series. PARTICIPANTS Treatment-naive nAMD patients (n=30) showing BALAD on optical coherence tomography (OCT) and undergoing anti-VEGF therapy. METHODS Clinical records and multimodal imaging were reviewed up to 4 years after diagnosis. MAIN OUTCOMES MEASURES Best-corrected visual acuity (BCVA) values were compared over time. The cumulative risk and the risk factors of subretinal fibrosis were assessed with Cox regression analyses, and the adjusted hazard ratio (aHR) was computed. RESULTS Thirty eyes of 30 patients were included. Macular neovascularization (MNV) subtypes were distributed as follows: type 1, 63%; type 2, 27%; mixed type 1 and type 2, 3%; type 3, 3%; aneurysmal type 1, 3%. The BCVA significantly improved after anti-VEGF loading phase (Snellen equivalent, from 20/118 to 20/71, P = 0.03), but it returned to baseline levels at 4 years (Snellen equivalent, 20/103, P = 0.6). The cumulative risk of subretinal fibrosis was 77% at 4 years. Risk factors associated with subretinal fibrosis included hemorrhagic BALAD (aHR, 2.02; 95% CI 1.54 to 3.22; P < 0.01) and the presence of subretinal hyperreflective material (aHR, 1.83; 95% CI 1.35 to 3.14; P < 0.01). CONCLUSIONS BALAD was found in association with all types of MNV in nAMD patients. Long-term observation revealed poor functional outcomes related to the high risk of subretinal fibrosis.