Fluid-based prognostication in n-AMD: Type 3 macular neovascularisation needs an analysis in isolation

Impact of Prolonged Persisting Subretinal Fluid on the Outcome of Aflibercept Treatment in Neovascular Age-Related Macular Degeneration

Purpose: To evaluate the effect of prolonged residual subretinal fluid (SRF) on the outcomes of aflibercept treatment in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). Methods: This retrospective study included patients diagnosed with neovascular AMD or PCV who presented with fovea-involving residual SRF that persisted for a minimum of 6 months while undergoing aflibercept treatment. Changes in best-corrected visual acuity (BCVA) during persistent SRF were evaluated. The factors associated with the risk of visual deterioration during this period were also investigated. Results: In total, 135 patients were included in this study. During this period, the duration of the presence of residual SRF was 17.1 ± 10.3 months and mean injection interval was 2.6 ± 0.7 months. The mean BCVA was changed from 0.30 ± 0.23(Snellen equivalents, 20/39) to 0.36 ± 0.28 (20/45). In 18 (13.3%) patients, ≥2 lines of visual deterioration was noted. The duration of persisting SRF (P = 0.008) and mean height of SRF (P = 0.005) were significantly associated with a high risk of visual deterioration. Among the 80 patients with mean SRF height <100 μm, ≥2 lines of visual deterioration were noted in 4 (5.0%) patients. Among 41 patients with the mean SRF height ≥100 μm and <200 μm and 14 patients with the mean SRF height ≥200 μm, the visual deterioration was noted in 8 (19.5%) and 6 (42.9%) patients, respectively. Conclusions: In cases of neovascular AMD or PCV in which SRF persists without complete resolution during treatment, minimizing the duration of persistent SRF and mean height of SRF is recommended to mitigate the risk of visual deterioration. ClinicalTrials.gov Identifiers: NCT05662943 (https://clinicaltrials.gov/study/NCT05662943?cond=type%201%20macular%20neovascularization&rank=2).

Difference in characteristics and lesion reactivation between type 3 macular neovascularization with and without subretinal fluid at baseline

PURPOSE

To compare the characteristics and incidence rates of lesion reactivation after anti-vascular endothelial growth factor (VEGF) treatment in type 3 macular neovascularization (MNV) with and without subretinal fluid (SRF) at baseline.

METHODS

This retrospective study included 95 patients diagnosed with type 3 MNV. After the initial loading injections, re-treatment was performed when lesion reactivation occurred defined as the re-accumulation of subretinal or intraretinal fluid or the new development of a retinal/subretinal hemorrhage. The differences in the baseline characteristics and the incidence rates of lesion reactivation were compared between patients with SRF (SRF group, n = 42) and those without SRF (non-SRF group, n = 53).

RESULTS

At diagnosis, the mean visual acuity was worse (0.68 ± 0.41 vs 0.50 ± 0.36; P = 0.032), mean central retinal thickness was greater (515.4 ± 145.9 μm vs 383.8 ± 105.5 μm; P < 0.001), and the incidence of focal retinal hemorrhages was higher (90.5% vs 66.0%; P = 0.005) in the SRF group than in the non-SRF group. In the SRF group, the first lesion reactivation was noted in 89.7% at a mean of 5.8 ± 4.4 months after the third injection. In the non-SRF group, the first lesion reactivation was noted in 70.6% at a mean of 6.1 ± 3.8 months. There was a significant difference in lesion reactivation between the two groups (P = 0.019).

CONCLUSIONS

The difference in the baseline characteristics and incidence of lesion reactivation between type 3 MNV with and without SRF suggests that the presence of SRF may be indicative of more advanced disease with a high risk of visual deterioration. This result also suggests the need for more active treatment to preserve vision in patients with SRF.

Difference Between the Incidence of Retinal Fluid Subtypes and Their Association with Visual Outcomes According to the Types of Macular Neovascularization in a Korean Population

Purpose: To investigate differences in the incidence of retinal fluid subtypes among different subtypes of macular neovascularization (MNV) and evaluate the influence of the presence of retinal fluid subtypes on visual outcome in each subtype of MNV. Methods: This retrospective study included 248 patients (248 eyes) diagnosed with treatment-naive neovascular age-related macular degeneration and polypoidal choroidal vasculopathy (PCV). The incidence of retinal fluid subtypes at diagnosis and during the 24-month follow-up was compared among the different subtypes of MNV. In addition, visual acuity was compared between patients with and without the retinal fluid subtypes. Results: At diagnosis, there was a significant difference in the incidence of subretinal fluid (SRF), intraretinal fluid (IRF), and subretinal pigment epithelial fluid among type 1 MNV, type 2 MNV, type 3 MNV, and PCV (P < 0.001). The incidence of SRF (P < 0.001) during follow-up also differed among the 4 groups. In patients with type 1 MNV and IRF, the visual acuity at diagnosis (P = 0.004) and at 24 months (P < 0.001) were significantly worse. However, the presence of SRF was not associated with poor visual acuity. In type 3 MNV, there was no significant difference in visual acuity between patients with and without SRF/IRF. Conclusion: The results of this study indicate that the clinical significance of retinal fluid subtypes may differ in different subtypes of MNV, suggesting the need for analysis in isolation of each MNV subtype in fluid-based prognostication.