gms | German Medical Science

Background: To determine the role of sub-retinal fluid in age-related macular degeneration concerning the long-term incidence of macular atrophy and clinical outcomes in eyes treated with anti-vascular endothelial growth factor therapy using a treat & extend regimen.

Methods: All patients with nAMD treated with anti-VEGF inhibitors since 2014 were screened for a sub-retinal fluid only phenotype, which was defined as follows: (I) Absence of intra-retinal fluid (IRF) from baseline or after anti-VEGF upload; (II) Continuous recurrence of fluctuating sub-foveal fluid responsive to anti-VEGF for a duration of ≥ 3 years. Sub-retinal fluid was treated as a sign of activity and not tolerated. Treatment was monitored using multimodal imaging.

Results: Twenty-seven eyes were included. Mean age was 72 ± 6 (range: 61 – 86) years. Choroidal neovascularization (CNV) was type 1 in 12 (44 %) and type 2 in 15 (56 %) eyes. The sub-retinal fluid only phenotype was seen from baseline in 14 eyes (52 %), and in the remaining 13 eyes (48 %) after a mean 1.0 ± 1.3 (1 – 3) injections. During a mean follow-up of 4.2 ± 0.9 (3 – 5) years, 7.5, 5.9, 6.1, 6.1 and 7.0 anti-VEGF injections were given in years 1 to 5 (p=0.33). Cumulative macular atrophy incidence was 11.5 % at year 1, 15.4 % throughout years 2 to 4, and 21.0 % at year 5. Mean visual acuity improved from baseline 37.8 to 43.9 ETDRS letters at year one (p=0.006) and remained stable through years 2 to 5 (p=0.20) to a final 42.8 letters.

Conclusion: Eyes manifesting activity by sub-retinal fluid only in treat & extend anti-VEGF regimen for neovascular AMD seem to exhibit little long-term atrophy and stable visual outcomes during long-term follow-up. Recurrence of subretinal fluid without intraretinal fluid might be an indicator of more a benign form of neovascular AMD.