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Non-neovascular fluid in age-related macular degeneration: observe-and-extend regimen in a case-series study

OBJECTIVETo describe the course of non-neovascular fluid in age-related macular degeneration (AMD) after anti-vascular endothelial growth factor (anti-VEGF) therapy or after observation without injections.DESIGNRetrospective case series.METHODSAMD eyes with macular drusen and (or) drusenoid pigment...

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Bibliographic Details
Published in:Canadian journal of ophthalmology 2023-12, Vol.58 (6), p.592-600
Main Authors: Santina, Ahmad, Romero-Morales, Veronica, Abraham, Neda, Somisetty, Swathi, Fogel-Levin, Meira, Bousquet, Elodie, Nudleman, Eric, Sadda, SriniVas, Sarraf, David
Format: Article
Language:English
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Summary:OBJECTIVETo describe the course of non-neovascular fluid in age-related macular degeneration (AMD) after anti-vascular endothelial growth factor (anti-VEGF) therapy or after observation without injections.DESIGNRetrospective case series.METHODSAMD eyes with macular drusen and (or) drusenoid pigment epithelial detachment associated with non-neovascular fluid were included. Optical coherence tomography (OCT) angiography was performed in all eyes to exclude the presence of macular neovascularization. Subretinal fluid (SRF) was measured to determine the response after anti-VEGF therapy and after observation without injections.RESULTSTen eyes of 9 patients with intermediate AMD and SRF were studied over a median period of 59.5 months (range, 7-128 months). Six patients (6 eyes) had a history of anti-VEGF therapy. Median follow-up off injections was 13.5 months (range, 4-44 months). SRF thickness remained stable and unchanged during the follow-up off injections in all eyes (n = 6) with prior injection and in all eyes (n = 4) that had never been injected. Six eyes developed complete retinal pigment epithelial (RPE) and outer retinal atrophy, and 1 eye developed incomplete RPE and outer retinal atrophy. All eyes exhibited at least 2 OCT biomarkers associated with a high risk for progression to atrophy.CONCLUSIONThis study provides preliminary data regarding the progression of non-neovascular fluid in AMD with or without anti-VEGF injections. A possible mechanism for fluid development may be related to RPE pump impairment. Distinguishing neovascular versus non-neovascular fluid using multimodal imaging, including OCT angiography, is essential to avoid unnecessary anti-VEGF therapy. An observe-and-extend regimen may be considered in AMD eyes with non-neovascular fluid.
ISSN:0008-4182
1715-3360
DOI:10.1016/j.jcjo.2022.08.005