June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Anti-VEGF Resistant Subretinal Fluid is Associated With Reduced Risk of Macular Atrophy and Better Visual Acuity: Drug-Induced Choroidal New Vessel Homeostasis?
Author Affiliations & Notes
  • Marco A Zarbin
    Inst. of Ophthalmology & Visual Science, Rutgers-New Jersey Medical School, Newark, New Jersey, United States
  • Ivo Stoilov
    Genentech, South San Francisco, California, United States
  • Lauren Hill
    Genentech, South San Francisco, California, United States
  • Footnotes
    Commercial Relationships   Marco Zarbin, Frequency Therapeutics (I), Frequency Therapeutics (C), Genentech (F), Genentech (C), Genentech (R), Iveric bio (I), Iveric bio (C), Novartis (C), NVasc (I); Ivo Stoilov, Genentech (E); Lauren Hill, Genenetech (E)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3503. doi:
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    • Get Citation

      Marco A Zarbin, Ivo Stoilov, Lauren Hill; Anti-VEGF Resistant Subretinal Fluid is Associated With Reduced Risk of Macular Atrophy and Better Visual Acuity: Drug-Induced Choroidal New Vessel Homeostasis?. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3503.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the relationship between subretinal fluid (SRF) thickness, vision outcomes, and the development of macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD) treated with ranibizumab in the HARBOR clinical trial.

Methods : HARBOR (NCT00891735) was a phase 3, randomized trial of ranibizumab (0.5 mg and 2 mg PRN or monthly) in eyes with nAMD. Presence and thickness of SRF was determined by SD-OCT. Eyes were grouped according to SRF thickness: 0 µm, >0-50 µm, >50-100 µm, or >100 µm. Best corrected visual acuity (BCVA) was assessed using standard Early Treatment Diabetic Retinopathy Study (ETDRS) protocols. Presence of MA was determined from fluorescein angiograms and color fundus photographs by masked graders. All treatment arms were pooled, and the analysis limited to eyes with SRF at baseline (defined as screening, baseline, or week 1; n=785).

Results : At month(M)-12, ranibizumab-treated eyes with residual SRF had greater mean ETDRS BCVA compared to eyes with no SRF regardless of the SRF thickness: no SRF, 63.6 letters; >0-50 µm SRF, 71.2 letters; >50-100 µm SRF, 71.3 letters; >100 µm SRF, 69.2 letters. Mean BCVA values were similar at M-24. In eyes with no MA at baseline, the presence of residual SRF at M-3 was associated with significantly lower rates of MA at M-12 and M-24 compared with eyes with resolved SRF at M-3. Specifically, the MA rate with residual vs resolved SRF at M-3 was 5.1% vs 26.3%, respectively, at M-12; and 13.2% vs 35.7%, respectively, at M-24. Similarly, in eyes with no MA at baseline, the presence of residual SRF at M-6 was also associated with significantly lower rates of MA at M-12 and M-24 compared with eyes with resolved SRF at M-6.

Conclusions : In this analysis, SRF was not found to be detrimental to vision outcomes over two years. In addition, rates of MA were significantly higher in the absence of SRF. These findings are consistent with earlier analyses. We posit that persistent SRF in the course of anti-VEGF treatment may be a sign of persistent choroidal new vessel perfusion with transudation, which may operate as an imperfect compensatory mechanism that maintains the function of the degenerating macula.

This is a 2020 ARVO Annual Meeting abstract.

 

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