Impact of Sub-Retinal Fluid on the Long-Term Incidence of Macular Atrophy in Neovascular Age-related Macular Degeneration under Treat & Extend Anti-Vascular Endothelial Growth Factor Inhibitors

• Published in: Scientific reports Vol. 10; no. 1; p. 8036
• Main Authors: Siedlecki, Jakob, Fischer, Cheryl, Schworm, Benedikt, Kreutzer, Thomas C., Luft, Nikolaus, Kortuem, Karsten U., Schumann, Ricarda G., Wolf, Armin, Priglinger, Siegfried G.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 15.05.2020; Nature Publishing Group
• Subjects: 692/308/409; 692/308/53; Age; Aged; Aged, 80 and over; Angiogenesis Inhibitors - pharmacology; Angiogenesis Inhibitors - therapeutic use; Angiography; Atrophy; Disease Susceptibility; Eye; Female; Follow-Up Studies; Humanities and Social Sciences; Humans; Incidence; Macula Lutea - diagnostic imaging; Macula Lutea - drug effects; Macula Lutea - metabolism; Macula Lutea - pathology; Macular degeneration; Macular Degeneration - diagnosis; Macular Degeneration - epidemiology; Macular Degeneration - metabolism; Macular Degeneration - therapy; Male; Middle Aged; multidisciplinary; Multimodal Imaging; Phenotypes; Prevalence; Retina; Science; Science (multidisciplinary); Subretinal Fluid - metabolism; Treatment Outcome; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-64901-9

Sub-retinal fluid (SRF) has been discussed as a protective factor against macular atrophy in eyes with neovascular age-related macular degeneration (nAMD).To gauge the impact of SRF on macular atrophy, a database of 310 nAMD eyes was screened for eyes manifesting an SRF-only phenotype under treat & extend anti-VEGF treatment, defined as nAMD expressing CNV exudation beyond the three monthly anti-VEGF loading doses by SRF only without any signs of exudative intra-retinal fluid (IRF) for ≥3 years. Incidence of macular atrophy and treatment responses were evaluated on multimodal imaging, including optical coherence tomography (OCT), blue autofluorescence (BAF) and near-infrared (NIR) confocal scanning laser ophthalmoscopy and fluorescence and indocyanine green angiography (FAG/ICGA). In total, 27 eyes (8.7%) of 26 patients with a mean follow-up of 4.2 ± 0.9 (3–5) years met the inclusion criteria. Mean age was 72 ± 6 (range: 61–86) years. The SRF only phenotype was seen from baseline in 14 eyes (52%), and in 13 eyes (48%) after a mean 1.0 ± 1.3 (1–3) injections. In years 1 to 5, mean 7.5, 5.9, 6.1, 6.1 and 7.0 anti-VEGF injections were given (p = 0.33). Cumulative macular atrophy incidence was 11.5% at year 1, 15.4% throughout years 2 to 4, and 22.4% at year 5. In conclusion, eyes manifesting activity by SRF only in treat & extend anti-VEGF regimen for nAMD seem to exhibit rather low rates of macular atrophy during long-term follow-up. SRF might be an indicator of a more benign form of nAMD.