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Zur D, Guymer R, Korobelnik JF, Wu L, Viola F, Eter N, Baillif S, Chen Y, Arnold JJ. Impact of residual retinal fluid on treatment outcomes in neovascular age-related macular degeneration. Br J Ophthalmol 2024:bjo-2024-325640. [PMID: 39033013 DOI: 10.1136/bjo-2024-325640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
Treatment decisions for neovascular age-related macular degeneration (nAMD) in the setting of individualised treatment regimens are adapted to disease activity. The main marker of disease activity and trigger for re-treatment with anti-vascular endothelial growth factor (anti-VEGF) agents is the presence of retinal fluid on optical coherence tomography (OCT). Recently, attention has focused on the impact of residual retinal fluid on nAMD management. Based on a literature review and the combined clinical experience of an international group of retinal specialists, this manuscript provides expert guidance on the treatment of nAMD according to fluid status and proposes an algorithm for determining when to administer anti-VEGF treatment according to residual fluid status. We explore the role of residual fluid in treatment decisions and outcomes in nAMD, taking into consideration fluid evaluation and, in particular, distinguishing between fluid in different anatomic compartments and at different stages during the treatment course. Current limitations to identifying and interpreting fluid on OCT, and the assumption that any residual retinal fluid reflects ongoing VEGF activity, are discussed.
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Affiliation(s)
- Dinah Zur
- Faculty of Medical and Health Sciences, Ophthalmology Division, Tel Aviv University, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Robyn Guymer
- Royal Victorian Eye and Ear Hospital, University of Melbourne, Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Jean-François Korobelnik
- Service d'ophtalmologie, CHU Bordeaux, Bordeaux, France
- Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, F-33000, Université de Bordeaux, Bordeaux, France
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica
| | - Francesco Viola
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicole Eter
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
| | - Stéphanie Baillif
- Department of Ophthalmology, Pasteur 2 Hospital, Nice Cote d'Azur University, Nice, France
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
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Patil NS, Mihalache A, Dhoot AS, Popovic MM, Muni RH, Kertes PJ. Association Between Visual Acuity and Residual Retinal Fluid Following Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2022; 140:611-622. [PMID: 35551359 PMCID: PMC9100487 DOI: 10.1001/jamaophthalmol.2022.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The association between residual subretinal fluid (SRF) and intraretinal fluid (IRF) and visual acuity following anti-vascular endothelial growth factor (VEGF) treatment is not well understood. Objective To examine the association of residual retinal fluid, SRF, and IRF with visual acuity following anti-VEGF treatment in patients with neovascular age-related macular degeneration (nAMD). Data Sources A systematic literature search was performed from January 2005 to August 2021 using Ovid MEDLINE, Embase, and the Cochrane Library. Study Selection Peer-reviewed articles reporting on visual acuity stratified by the presence or absence of any residual SRF, IRF, or any retinal fluid at last study observation after intravitreal bevacizumab, ranibizumab, aflibercept, or brolucizumab in patients with nAMD were included. Studies that were noncomparative, included fewer than 10 eyes, or reported on other anti-VEGF agents were excluded. Data Extraction and Synthesis Two independent reviewers conducted data extraction and synthesis. The Cochrane risk of bias tool 2 and ROBINS-I were used to assess risk of bias and GRADE evaluation was conducted to assess certainty of evidence. Main Outcomes and Measures Primary outcomes were BCVA at last study observation, change in BCVA from baseline, and retinal thickness at last study observation. Results In this systematic review and meta-analysis, 11 studies (6 randomized clinical trials [RCTs]) comprising 3092 eyes were included in our analysis. Across all included studies, the BCVA of eyes with residual SRF was better than eyes without SRF (weighted mean difference [WMD], 3.1 letter score; 95% CI, 0.05 to 6.18; P = .05; GRADE, low certainty of evidence; 6 studies; 1931 eyes) but similar in RCTs (WMD, 2.7 letter score; 95% CI, -2.40 to 7.84; P = .30; GRADE, low certainty of evidence; 3 studies; 1406 eyes). The BCVA of eyes with residual IRF was worse than that of eyes without IRF (WMD, -8.2 letter score; 95% CI, -11.79 to -4.50; P < .001; GRADE, low; 7 studies; 2114 eyes). Conclusions and Relevance The findings suggest that the presence of residual SRF was associated with slightly better BCVA at last study observation; however, baseline differences in BCVA existed and this conclusion was primarily driven by 1 study. The presence of residual IRF was associated with substantially worse BCVA at last study observation and less improvement of BCVA from baseline. The conclusions are limited by the inclusion of data from observational studies, heterogeneity, and a low certainty of evidence.
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Affiliation(s)
- Nikhil S Patil
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Mihalache
- Department of Basic Medical Sciences, Faculty of Sciences, University of Western Ontario, London, Ontario, Canada
| | - Arjan S Dhoot
- Undergraduate Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Chaudhary V, Matonti F, Zarranz-Ventura J, Stewart MW. IMPACT OF FLUID COMPARTMENTS ON FUNCTIONAL OUTCOMES FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Systematic Literature Review. Retina 2022; 42:589-606. [PMID: 34393212 PMCID: PMC8946587 DOI: 10.1097/iae.0000000000003283] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Understanding the impact of fluid in different retinal compartments is critical to developing treatment paradigms that optimize visual acuity and reduce treatment burden in neovascular age-related macular degeneration. This systematic review aimed to determine the impact of persistent/new subretinal fluid, intraretinal fluid, and subretinal pigment epithelial fluid on visual acuity over 1 year of treatment. METHODS Publication eligibility and data extraction were conducted according to Cochrane methods: 27 of the 1,797 screened records were eligible. RESULTS Intraretinal fluid negatively affected visual acuity at baseline and throughout treatment, with foveal intraretinal fluid associated with lower visual acuity than extrafoveal intraretinal fluid. Some studies found that subretinal fluid (particularly subfoveal) was associated with higher visual acuity at Year 1 and longer term, and others suggested subretinal fluid did not affect visual acuity at Years 1 and 2. Data on the effects of subretinal pigment epithelial fluid were scarce, and consensus was not reached. Few studies reported numbers of injections associated with fluid status. CONCLUSION To optimally manage neovascular age-related macular degeneration, clinicians should understand the impact of fluid compartments on visual acuity. After initial treatment, antivascular endothelial growth factor regimens that tolerate stable subretinal fluid (if visual acuity is stable/improved) but not intraretinal fluid may enable patients to achieve their best possible visual acuity. Confirmatory studies are required to validate these findings.
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Affiliation(s)
- Varun Chaudhary
- Hamilton Regional Eye Institute, St Joseph's Healthcare Hamilton, Department of Health Research Methods, Evidence and Impact, McMaster University, Division of Ophthalmology, Department of Surgery, McMaster University, Canada;
| | - Frédéric Matonti
- Centre Monticelli Paradis, 433 bis rue Paradis, Marseille, France and Aix Marseille University, CNRS, INT, Inst Neurosci Timone, Marseille, France and Clinique Juge, Groupe Almaviva Santé, Marseille, France;
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, and Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; and
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Core JQ, Pistilli M, Daniel E, Grunwald JE, Toth CA, Jaffe GJ, Hua P, Martin DF, Ying GS, Maguire MG. Predominantly Persistent Subretinal Fluid in the Comparison of Age-Related Macular Degeneration Treatments Trials. Ophthalmol Retina 2021; 5:962-974. [PMID: 34126249 PMCID: PMC8478884 DOI: 10.1016/j.oret.2021.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/30/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe predominantly persistent subretinal fluid (SRF) in eyes receiving ranibizumab or bevacizumab for neovascular age-related macular degeneration and to compare visual acuity (VA) to eyes with nonpersistent SRF. DESIGN Cohort within randomized clinical trial. PARTICIPANTS Comparison of Age-related Macular Degeneration Treatments Trials patients assigned to pro re nata treatment. METHODS Graders evaluated monthly OCT scans for SRF. Predominantly persistent SRF through week 12 was defined as SRF at baseline and weeks 4, 8, and 12. Predominantly persistent SRF through 1 or 2 years was defined as SRF in 80% or more of visits by years 1 or 2, respectively. Linear regression models including baseline predictors of VA and predominantly persistent intraretinal fluid (IRF) were used to evaluate mean differences in vision outcomes. PRIMARY OUTCOME MEASURES Predominantly persistent SRF through year 1, adjusted VA score and VA change, and foveal SRF thickness. RESULTS Among 406 eyes with baseline SRF, SRF persisted in 108 eyes (26.6%) through week 12, in 94 eyes (23.2%) through year 1, and in 77 eyes (19.0%) through year 2. Adjusted VA means at year 1 were similar between eyes with predominantly persistent versus non persistent SRF by week 12 (68.1 vs. 70.2 letters; P = 0.18), year 1 (67.6 vs. 70.2 letters; P = 0.11), and year 2 (71.4 vs. 70.9 letters; P = 0.78). Adjusted changes in mean VA at year 1 were similar between eyes with predominantly persistent versus nonpersistent SRF by week 12 (6.3 vs. 7.6 letters; P = 0.38), year 1 (5.5 vs. 7.8 letters; P = 0.14), and year 2 (8.1 vs. 7.7 letters; P = 0.78). Among eyes with predominantly persistent SRF through year 1, foveal SRF was absent in 46 eyes (48.9%), thickness was 1 to 200 μm in 48 eyes (50.0%) and more than 200 μm in 1 eye (1.1%) at year 1. CONCLUSIONS Eyes with predominantly persistent and nonpersistent SRF through week 12, year 1, or year 2 showed similar VA outcomes after adjustment for baseline covariates and persistent IRF. At the foveal center, predominantly persistent SRF was most commonly absent or present in small quantities.
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Affiliation(s)
- Jason Q Core
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Maxwell Pistilli
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ebenezer Daniel
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan E Grunwald
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Peiying Hua
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel F Martin
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, and National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Gui-Shuang Ying
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Korobelnik JF, Souied EH, Oubraham H, Razavi S, Mauget-Faÿsse M, Savel H, Chene G, Wolf S. ASSESSMENT OF EARLY CHANGES IN SPECTRAL DOMAIN-OPTICAL COHERENCE TOMOGRAPHY AFTER INITIATION OF TREATMENT WITH INTRAVITREAL AFLIBERCEPT (EYLEA) OVER A 12-WEEK PERIOD FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Multicenter French Study (START). Retina 2021; 41:588-594. [PMID: 33600134 DOI: 10.1097/iae.0000000000002910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess early changes in spectral-domain optical coherence tomography during the loading phase with intravitreal aflibercept therapy in patients with neovascular age-related macular degeneration. METHODS In this prospective, open-label, single-arm, multicenter study, patients with neovascular age-related macular degeneration, who were antivascular endothelial growth factor treatment-naïve, received three monthly initial doses of intravitreal aflibercept 2 mg. The primary outcome was the proportion of patients with dry spectral-domain optical coherence tomography at 12 weeks, defined as an absence of intraretinal edema, intraretinal cysts, subretinal fluid, and subretinal pigment epithelium fluid. RESULTS Fifty eyes of 50 patients were investigated. At 12 weeks, 34.0% (17/50) had dry spectral-domain optical coherence tomography. Marked reductions were observed for all other spectral-domain optical coherence tomography parameters. The mean macular central thickness fell significantly from 463.2 ± 184.3 µm at baseline to 288.9 ± 76.8 µm at Week 12 (P < 0.0001). The mean best-corrected visual acuity also improved significantly from 61.0 ± 16.0 letters at baseline to 66.6 ± 19.0 letters at Week 12 (P = 0.0006). CONCLUSION The anatomic and functional outcomes improved over the 12-week study period. All outcome variables peaked after the third aflibercept injection, confirming the benefit of three initial doses.
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Affiliation(s)
- Jean-François Korobelnik
- Service D'Ophtalmologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Leha team, UMR 1219, Bordeaux, France
| | - Eric H Souied
- Department of Ophthalmology, Hôpital Intercommunal de Créteil, University Paris Est, Créteil, France
| | - Hassiba Oubraham
- Department of Ophthalmology, Hôpital Intercommunal de Créteil, University Paris Est, Créteil, France
| | - Sam Razavi
- Centre Ophtalmologique Transparence Tours, Tours, France
| | | | - Helene Savel
- CHU de Bordeaux, Pôle de santé publique, Unité de soutien méthodologique à la recherche clinique et épidémiologique and CIC 1401-EC, Bordeaux, France ; and
| | - Genevieve Chene
- CHU de Bordeaux, Pôle de santé publique, Unité de soutien méthodologique à la recherche clinique et épidémiologique and CIC 1401-EC, Bordeaux, France ; and
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Qin J, An L. Optical Coherence Tomography for Ophthalmology Imaging. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 3233:197-216. [PMID: 34053029 DOI: 10.1007/978-981-15-7627-0_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Optical coherence tomography (OCT) is a depth-resolved imaging modality, which is able to achieve micrometer-scale resolution within biological tissue noninvasively. In the past 30 years, researchers all around the world had made several essential efforts on techniques relevant to OCT. OCT has become a routine process for eye diseases with different types. In this chapter, the three important stages in the development of OCT are briefly illustrated, including the time domain OCT (TD-OCT), the frequency domain OCT (FD-OCT) and the optical coherence tomography angiography (OCTA). Each of the technique has made great progress for use on living human eye imaging in clinical applications. TD-OCT was first proposed and commercialized, which is able to achieve acceptable 2D depth-resolved cross-sectional images of human retina in vivo. FD-OCT was the upgraded OCT technique compared with TD-OCT. By capturing the coherent signal within the Fourier space, the FD-OCT could improve the image sensitivity compared with TD-OCT, and achieve dozens of kilo hertz imaging speed. OCTA is the newest developments of OCT technique, which is able to visualize the micro vasculature networks of human retina in vivo. With OCTA technique, the newest ophthalmologic OCT system is able to achieve detailed diagnosis for both micro-structure and vasculature abnormalities for clinical applications. The further development of OCT technique on imaging speed, contrast, resolution, field of view, and so on will make OCT to be a more powerful tool for clinical usages.
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Affiliation(s)
- Jia Qin
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd, Foshan, Guangdong, People's Republic of China
| | - Lin An
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd, Foshan, Guangdong, People's Republic of China
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