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Kavita Bhavsar, K Bailey Freund; Retention of Good Visual Acuity in Eyes with Neovascular Age-Related Macular Degeneration and Chronic Refractory Subfoveal Subretinal Fluid. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3972.
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To describe the clinical characteristics of a subset of eyes with neovascular age-related macular degeneration (NVAMD) receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy which retain good visual acuity despite chronic, persistent, subfoveal subretinal fluid (SRF).
Study eyes were identified from a consecutive series of 186 NVAMD patients being treated with anti-VEGF therapy seen for regular follow-up over a 3-month period. The clinical histories of 10 eyes of 9 patients with NVAMD, chronic subfoveal SRF despite continuous anti-VEGF therapy, and good long-term visual acuity of 20/40 were reviewed. Demographic factors, baseline and final visual acuity, neovascular lesion type, duration of persistent fluid, baseline and final subfoveal choroidal thickness, and number of anti-VEGF injections were analyzed.
The mean age of patients was 78 years (range 55-91). The mean duration of persistent subfoveal fluid was 5.2 years (range 1.3 - 11.0). Long-term visual acuities remained stable at 20/40 or better in all eyes. All eyes had type 1 (sub-retinal pigment epithelial) neovascularization. Average baseline subfoveal choroidal thickness was 285.3µm and the average subfoveal choroidal thickness at last follow-up examination was 239.7µm. The mean number of injections was 36.5 (range 17-66).
Some eyes with type 1 neovascularization associated with chronic persistent subfoveal subretinal fluid despite continuous intravitreal anti-VEGF therapy may maintain good long-term visual outcomes. We hypothesize that type 1 neovascularization and greater subfoveal choroidal thickness may exert a protective effect on photoreceptor integrity. Further studies are necessary to assess long-term visual prognosis and predictive factors in patients with type 1 choroidal neovascularization leading to persistent subretinal fluid that is recalcitrant to anti-VEGF treatment.
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