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Huphy Saulah Ghayur, Deven Deonarain, Daniel Rosenberg, Varun Chaudhary; Prognostic role of baseline retinal fluids on visual acuity in patients with Wet-AMD: Systematic review. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1805.
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Wet age-related macular degeneration (wAMD) is a chronic retinal disease and a leading cause of vision loss in patients over the age of 60. The purpose of this study is to systematically review literature to determine the prognostic role of subretinal fluid (SRF), intraretinal fluid (IRH), serous PED (sPED) and fibrous PED (fPED) on long-term visual acuity outcomes in patients with wAMD.
A literature search was conducted on Medline, Embase and Cochrane Library, inception to Nov. 2019. Inclusion criteria consisted of published randomized control trials (RCTs) and observational studies presenting follow-up best-corrected visual acuity (BCVA) outcomes stratified based on the presence or absence of the desired prognostic factors. In accordance with PRISMA, reviewers examined eligibility and quality of publications. Descriptive and quantitative data were extracted using random-effects model.
The search identified 845 publications - 3 RCTs, 1 prospective and 4 retrospective cohort studies. Involving 3625 patients with a mean age of 79; 1467 males. FOR ETDRS change at 1 year follow up, baseline presence of subretinal fluid was associated with an increase in mean difference (MD) of letters by 1.94 (3 studies; 95%CI 0.77 to 3.11;P=0.001). At 5 years, SRF improved BCVA with a MD of 6.7 letters (1 study; 6.21 to 7.19;P<0.00001). Examining the presence and absence of IRF, ETDRS change at 1 year indicated no BCVAdifference, MD -0.86 letters (3 studies; -3.36 to 1.65;P=0.5). At 5 years, presence of IRF decreased BCVA, MD -2 letters (1 study; -2.35 to -1.65;P<0.00001). A study reporting 1-year logMAR BCVA, showed no significant difference in VA for baseline presence or absence of SRF (n=116;P=0.49). However, an increase in 1-year BCVA for patients without baseline IRF was observed (P=0.0083). A study examining serous PED highlighted a significant increase in logMAR BCVA at 3, 6 and 12-month follow-ups (P=0.001, P=0.002 and P=0.004,respectively). Fibrous PED improved logMAR BCVA at 3 months (P=0.02) but was not significant at 6 and 12 months (P=0.153 and P=0.393).
The role of SRF and IRF has shown mixed results. wAMD patients with baseline SRF are associated to have improved BCVA prognosis. IRF is associated with poorer VA outcomes. Literature is limited and heterogeneity is high. More research is required to better identify the roles of retinal fluids on long-term BCVA.
This is a 2020 ARVO Annual Meeting abstract.
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