Retinal Fluid Location Can Foretell Acuity After Anti-VEGF Treatments

Patients with residual subretinal fluid (SRF) following anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (nAMD) have superior best-corrected visual acuities (BCVA) to those who were left with other residual fluids, according to research published in JAMA Ophthalmology. The finding “suggests that allowing some residual SRF may be acceptable, whereas residual IRF may merit a more aggressive treatment regimen,” according to the study’s authors.

Investigators at the University of Toronto in Canada searched publication databases through August 2021 for studies of residual SRF, intraretinal fluid (IRF), or any retinal fluid following anti-VEGF therapy for nAMD. The primary outcomes were BCVA at final follow, change in BCVA from baseline, and retinal thickness.

A total of 6 randomized controlled trials and 5 observational studies comprising 3092 eyes were included. The patients were aged mean 72.9 to 79.4 years and baseline BCVA ranged between 47.8 to 69.5 ETDRS letters.

In the analysis of SRF vs no SRF, BCVA at final follow-up was superior among the patients with SRF (mean difference [MD], 3.12; 95% CI, 0.05-6.18; P =.05; I², 50%).

No differences between SRF or no SRF were observed for change in BCVA from baseline (MD, -0.07; 95% CI, -3.53 to 3.39; P =.97; I², 60%) or retinal thickness (MD, 23.88; 95% CI, -17.77 to 65.54; P =.26; I², 0%).

For IRF vs no IRF, BCVA at final follow-up was superior among patients with no IRF (MD, -8.15; 95% CI, -11.79 to -4.50; P <.001; I², 63%) as was change in BCVA from baseline (MD, -5.27; 95% CI, -7.46 to -3.07; P <.001; I², 0%).

No difference between IRF and no IRF was observed for retinal thickness (MD, 46.04; 95% CI, -27.93 to 120.1; P =.22; I², 87%).

Among patients with and without any fluid, no fluid was favored for final BCVA (MD, 3.44; 95% CI, 0.75-6.12; P =.01; I², 55%), change in BCVA from baseline (MD, 3.86; 95% CI, 0.83-6.88; P =.01; I², 40%), and retinal thickness (MD, -119.39; 95% CI, -168.74 to -70.04; P <.001; I², 69%).

The major limitation of this study was the overall paucity of published data regarding retinal fluid following anti-VEGF therapy in nAMD.

This study found that the presence of IRF or any retinal fluid following anti-VEGF therapy for nAMD was associated with poorer visual outcomes.

Disclosure: Multiple authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please refer to the original article for a full list of disclosures.

Reference

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. Published online May 12, 2022. doi:10.1001/jamaophthalmol.2022.1357