Non-Neovascular Fluid in Age Related Macular Degeneration: Observe and Extend

Abstract

Purpose : Presence of fluid on optical coherence tomography (OCT) in age-related macular degeneration (AMD) is considered a biomarker of neovascular activity. However, recent evidence has shown that fluid does not always indicate neovascularization. Our goal was to describe non-neovascular fluid in AMD and its response to anti-VEGF treatment or observation.

Methods : This observational case series included AMD eyes with macular drusen and/or drusenoid pigment epithelial detachment associated with non-neovascular fluid. OCTA was performed in all eyes to exclude the presence of macular neovascularization at multiple visits. Subretinal fluid (SRF) was tracked and measured to determine the response to anti-VEGF therapy and observation without injections.

Results : 10 eyes of 9 patients with intermediate AMD and SRF were studied over a median period of 54 months (Range: 5.5 months-10 years). Median visual acuity at first visit with documented fluid in logMAR was 0.2 (Snellen equivalent 20/30) with a range of 0-0.4 (20/20–20/50). 6 eyes had a history of anti-VEGF therapy with a median number of 3 injections (Range: 3–27 injections). Median follow-up while receiving injections was 3.5 months (Range: 2–48 months) while median follow-up off injections was 12 months (Range: 4-43 months). None of the eyes responded to anti-VEGF injections except for one eye that showed a response after 1 injection but no response after subsequent injections. 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) never injected. 5 out of the 10 eyes developed geographic atrophy and CRORA and one eye developed IRORA and all eyes exhibited at least 2 out of 5 OCT biomarkers of atrophy.

Conclusions : This 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 OCTA, is essential to avoid unnecessary anti-VEGF injection.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

 

OCTA scans at Outer Retina (A) and Choriocapillaris (B) Segmentation slabs show no neovascularization. (C,D,E,F). SD OCT scans at baseline visit (C) during which the last anti-VEGF injection was given and after 3 weeks (D), 11 weeks (E) and 24 weeks (F) show persistence of fluid with observation.