Influence of different fluid types on the development of fibrosis and atrophy in patients with nAMD

Abstract

Aims/Purpose: Subretinal fibrosis and macular atrophy often associated with vision loss are regularly seen in patients with long‐term neovascular age‐related macular degeneration (nAMD). Apart from the influence of fluid distribution on visual acuity its effect on the development of fibrotic and atrophic alterations could give important insight for better understanding the pathogenesis of end‐stages and might influence treatment decisions. Hence, we investigated the influence of fluid distribution on fibrosis and atrophy using AI‐supported fluid quantification.Methods: Sub‐ and intra‐retinal fluid (SRF and IRF) and pigment epithelium detachment (PED) were quantified on optical coherence tomography (OCT) volumetric scans using the Vienna Fluid Monitor, Version 2 (RetInSight, Vienna, Austria) at all timepoints until the appearance of atrophy or fibrosis evaluated by the Vienna Reading Center (VRC). In total, 569 treatment naïve nAMD patients were included in the analysis. A disease activity‐dependent treat&extend‐based anti‐VEGF treatment regimen was used. A logistic regression model for fibrosis/atrophy was created.Results: Fluid distribution and dynamics showed a significant influence on the development of fibrosis/atrophy. If the standard deviation of IRF increased by 1 unit (100 nL; p = 0.006) odds to develop fibrosis increased by 4.4. Hence, patients with little IRF at baseline that increased rapidly during the following visits were likely to develop fibrosis. However, atrophy did not seem to be influenced by IRF significantly, whereas PED and SRF showed a significant influence on the development of MA.Conclusions: Automated assessment of fluid type and volume using artificial intelligence allows an objective and precise assessment of the activity of IRF, SRF and PED and therefore its influence on the development of fibrosis or atrophy. AI‐based fluid monitoring offers guidance to improve anatomical and visual outcomes in the long‐term management of nAMD in clinical routine.