Retinal Exudates Result in Worse Long-Term Visual Acuity

A study shows exudative eyes that had inferior posterior staphyloma (IPS) without choroidal neovascularization (CNV) and a relatively better baseline best-corrected visual acuity (BCVA), experienced a spontaneous decline in acuity in a span of 4 years, whereas relatively worse baseline BCVA in eyes with IPS and CNV did not decline in the 4 year study period. Researchers speculate that this divergence is due to the presence of exudates in the first group, which was controlled in the second group with anti-vascular endothelial growth factor (VEGF) treatments, the American Journal of Ophthalmology report shows.

“Anti-VEGF therapy would be effective for long-term maintenance of BCVA in eyes with IPS with CNV, similar to other diseases with CNV,” according to the investigators.

The prospective clinical cohort study looked at 56 eyes of 43 consecutive patients with IPS divided into 3 groups from baseline findings: Eyes without CNV or retinal exudate (no-exudate group), eyes without CNV and with retinal exudate (exudate group), and eyes with CNV (CNV group). Patients were followed for 4 years; BCVA and associated parameters were measured in that duration.

Investigators found that, while BCVA declined in the 4-year follow-up in the exudate group (P  =.002), it was maintained for the same time span in the no-exudate and CNV groups (P =.53 and P =.20, respectively). 

“Baseline BCVA was lower in the CNV group than in the exudate group (P =.004),” the study says. “However, the 4-year BCVA was not (P  =.84). The 4-year BCVA was associated with baseline BCVA in all groups.” 

The patients in the CNV group received 9.0±8.7 anti-VEGF injections in the 4 years.

The study’s limitations include its small sample size and the fact that a treatment regimen for exudative IPS with CNV has not been identified. 

“Long-term retinal exudate would induce retinal damage and subsequent BCVA decline even in eyes with IPS without CNV,” investigators explain. “The 4-year BCVA was significantly associated with baseline subretinal fluid height only in the exudate group. Subretinal fluid  status would play an essential role in long-term visual outcome. By contrast, in eyes with IPS with CNV, lower baseline BCVA did not further decline in 4 years, probably because retinal exudates were under control due to treatments including anti-VEGF therapy.”

Reference

Doi A, Miyata M, Ooto S, et al. Long-term visual outcome in inferior posterior staphyloma and efficacy of treatment for complicated choroidal neovascularization. Am J Ophthalmol. Published online April 7, 2021. doi:10.1016/j.ajo.2021.02.034.