Abstract
We investigated the characteristics of neovascular age-related macular degeneration (AMD) in which exudation predominantly occurs as a subretinal fluid (SRF) during anti-vascular endothelial growth factor (VEGF) treatment. A total of 509 treatment-naïve neovascular AMD patients treated with anti-VEGF for 24 months were retrospectively analyzed. The baseline characteristics to determine the odds of occurrence of SRF alone were evaluated using multivariate modeling. SRF was the sole manifestation of lesion activity in 209 (40.9%) eyes during follow-up. The visual outcome of eyes with only SRF occurrence during follow-up was comparable to that of eyes without exudative recurrence. In addition, the incidence of macular atrophy was significantly lower in eyes with only SRF occurrence (9.6%, 20 of 208 eyes) than in eyes without exudative recurrence (16.7%, 9 of 54 eyes, P = 0.018). Multivariate analysis revealed that better best-corrected visual acuity (BCVA) at baseline (odds ratio [OR], 0.306; P = 0.001), presence of SRF alone at baseline (OR, 5.256; P < 0.001), lower pigment epithelial detachment (PED) height (less than 100 µm; OR, 4.113; P = 0.025), and aneurysmal type 1 macular neovascularization (MNV) (OR, 2.594; P = 0.002) were associated with an increased likelihood of SRF occurrence during follow-up. In conclusion, the eyes with only SRF occurrence during anti-VEGF treatment showed more favorable visual outcomes and a lower incidence of macular atrophy. The baseline characteristics, including better baseline BCVA, presence of SRF alone at baseline, lower PED height, and MNV subtype, might influence the predominant development of SRF during anti-VEGF treatment.
Highlights
We investigated the characteristics of neovascular age-related macular degeneration (AMD) in which exudation predominantly occurs as a subretinal fluid (SRF) during anti-vascular endothelial growth factor (VEGF) treatment
Subjects who met the following inclusion criteria were enrolled after database screening: (1) over 50 years old; (2) neovascular AMD confirmed with spectral-domain Optical coherence tomography (OCT) (SD-OCT), fluorescein angiography (FA), and/or indocyanine green angiography (ICGA) at the first visit; (3) no previous treatment before diagnosis; (4) treatment with anti-VEGF; and (5) completed follow-up for more than 24 months
The breakdown of the outer blood–retinal barrier leads to exudation into the subretinal space (SRF), and breakdown of the external limiting membrane leads to exudation into the neurosensory retina (IRF)[17]
Summary
We investigated the characteristics of neovascular age-related macular degeneration (AMD) in which exudation predominantly occurs as a subretinal fluid (SRF) during anti-vascular endothelial growth factor (VEGF) treatment. Multivariate analysis revealed that better best-corrected visual acuity (BCVA) at baseline (odds ratio [OR], 0.306; P = 0.001), presence of SRF alone at baseline (OR, 5.256; P < 0.001), lower pigment epithelial detachment (PED) height (less than 100 μm; OR, 4.113; P = 0.025), and aneurysmal type 1 macular neovascularization (MNV) (OR, 2.594; P = 0.002) were associated with an increased likelihood of SRF occurrence during follow-up. The association between the fluid type on OCT and visual outcomes has been reported by the post hoc analysis of multiple clinical trials including the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)[5] and VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD (VIEW 2)[6]. The FLUID trial demonstrated that SRF up to 200 μm at the foveal center does not entail worse visual outcomes if left u ntreated[8]
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