Abstract
Purpose :
There has been a lot of debate about fluids in nAMD. Several studies have recently reported tolerating SRF in nAMD. However, none of the studies revealed the morphologic characteristics of nAMD with tolerable SRF. This study is aimed to present the morphologic characteristics of nAMD with tolerable SRF.
Methods :
This is a longitudinal observational case series study. Tolerable SRF was defined as nAMD patient even with resistant SRF who maintained good visual acuity (VA) with no deterioration. Those patients with tolerable SRF at least 6 months were enrolled. They underwent additional anti-VEGF and observed for six-more months. Patients who showed deterioration of VA or appearance of hemorrhage and intraretinal fluid (IRF) during the study period were excluded. Structural OCT was performed to evaluate detailed PED and SRF morphology. OCT angiography was also performed to confirm CNV activity by evaluating morphology, size, and vascular density of CNV from en face images, and relative flow area from cross-sectional images. These parameters and visual acuity were assessed at 4 time points; SRF recurrence, study enrollment, last injection and last follow-up.
Results :
A total of 25 eyes from 25 patients with nAMD with tolerable SRF were included in the study. The naïve diseases causing tolerable SRF were typical nAMD in 8 eyes (32%), PCV in 12 eyes (48%), and pachychoroid neovasculopathy (PNV) in 5 eyes (20%). During the study period, there were no statistically significant changes in VA, SRF height and CNV activity; size, vascular density and relative flow area, respectively (all P>0.05). Remarkably, during tolerable SRF span, all patients showed common morphological characteristics, which were vascularized shallow irregular PED with low activity, serous SRF, and absence of IRF.
Conclusions :
Although initial CNV morphologic characteristics were different from each other, nAMD with tolerable SRF showed common morphological characteristics in OCT and OCT angiography. Hypothetically, remodeling of CNV following multiple treatments may eventually lead to this common morphology, Therefore, if a patient has eyes with nAMD with tolerable SRF could be managed with very relaxed Tx protocol
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.