Abstract
BackgroundTo analyze the long-term effects of persistent subretinal fluid (SRF) on visual/anatomic outcomes according to the type of macular neovascularization (MNV) during relaxed treat-and-extend regimen with anti-vascular endothelial growth factor (anti-VEGF) agents in age-related macular degeneration (AMD) patients.MethodsPatients with fovea-involving type 1 or type 2 MNV, treated with a relaxed treat-and-extend regimen for 2 years were retrospectively reviewed. Eyes with SRF observed more than three times per year were defined as the ‘persistent SRF (+) group’. To exclude the effects of IRF as much as possible, the eyes with persistent IRF were excluded. The effects of persistent SRF on the best-corrected visual acuity (BCVA), central subfield retinal thickness (CST), and changes in the photoreceptor layer (PRL) thickness and outer retinal bands (external limiting membrane, ellipsoid zone, and cone outer segment tip line) after anti-VEGF injection were analyzed for each MNV type.ResultsSeventy-seven eyes with type 1 MNV (44 eyes with persistent SRF) and 53 eyes with type 2 MNV (18 eyes with persistent SRF) were enrolled. Following a relaxed treat-and-extend regimen with anti-VEGF agents, BCVA and CST improved for each MNV type. In comparison between persistent SRF (+) and persistent SRF (−) group, there were no differences in the amount of change in BCVA and CST between the two groups for each MNV type during 2-year follow-up periods. In addition, there were no differences in the amount of reduction in PRL thickness and state of the outer retinal bands between the two groups for each MNV type.ConclusionsUsing a relaxed treat-and-extend regimen with anti-VEGF agents, persistent SRF did not have additional effects on visual and anatomic outcomes by 2 years, regardless of the MNV type.
Highlights
Optical coherence tomography (OCT) has become a valuable noninvasive retinal imaging modality that provides useful parameters for diagnosis and follow-up monitoring in treatment of patients with exudative agerelated macular degeneration (AMD) [1]
Treatment decisions for treatand-extend or pro re nata (PRN) regimen are often driven by the presence of fluid on OCT to reduce the number of anti-vascular endothelial growth factor injections [7]
Regarding macular neovascularization (MNV) type and its association with visual prognosis, several studies have reported that minimally classic and classic lesions were associated with poorer visual outcomes, and they required more injections of anti-Vascular endothelial growth factor (VEGF) than occult lesions [13, 14]. These results suggest that the visual prognosis of exudative age-related macular degeneration (AMD) after anti-VEGF treatment may vary with MNV types
Summary
Optical coherence tomography (OCT) has become a valuable noninvasive retinal imaging modality that provides useful parameters for diagnosis and follow-up monitoring in treatment of patients with exudative agerelated macular degeneration (AMD) [1]. In the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) study, the greater proportion of patients who achieved a dry retina was not correlated with the proportion of patients who gained visual acuity improvement of more than 15 letters [8]. Another randomized clinical trial reported that there was a minimal difference between the proportions of patients who had visual acuity improvement of more than 15 letters despite the difference in the proportions of patients achieving dry retina [6] These results question whether it is always necessary to resolve SRF completely in retina when treating AMD. To analyze the long-term effects of persistent subretinal fluid (SRF) on visual/anatomic outcomes according to the type of macular neovascularization (MNV) during relaxed treat-and-extend regimen with antivascular endothelial growth factor (anti-VEGF) agents in age-related macular degeneration (AMD) patients
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