Abstract
Purpose :
While anti-vascular endothelial growth factor (anti-VEGF) therapy has become the mainstay of neovascular age-related macular degeneration (nAMD) treatment, many patients have persistent edema after 12 weeks of treatment, termed early residual fluid (ERF). Post hoc analyses have characterized visual outcomes for eyes with ERF, demonstrating visual impact up to 12 months, but long-term prognosis for these patients in a real-world clinical setting is unknown. The purpose of this study is to characterize 24- and 36-month outcomes of nAMD patients with ERF and identify demographic and cardiovascular (CV) factors associated with the presence of ERF.
Methods :
This was a retrospective cohort study of 270 patients with nAMD at a single tertiary care center. Baseline, 12-, 24-, and 36-month best visual acuity (BVA) and central subfield thickness (CST) were compared between ERF-free patients and those with intraretinal fluid (IRF), subretinal fluid (SRF), or a combination (IRF+SRF) after 12 weeks as identified through a validated machine learning algorithm. Linear regression was used to identify factors associated with 24- and 36-month changes in BVA and CST, and logistic regression was used to identify CV factors associated with ERF.
Results :
ERF eyes with IRF presented with the lowest mean BVA (±SD) of 46.8±20.4 letters, while those with SRF presented with the highest BVA (66.9±14.9 letters). Eyes with IRF+SRF presented with lower baseline vision (56.2±19.6 letters) than ERF-free eyes (61.3±18.5 letters). Despite significant differences in BVA throughout follow-up, the change in BVA from baseline was similar between all ERF subgroups and eyes without ERF throughout the 36-month period. Similar trends were noted for CST, though IRF+SRF patients experienced greater CST improvements than SRF patients at 36 months. IRF presence at 12 weeks was significantly and negatively associated with 24-month changes in CST (p=0.001) and BVA (p=0.04), and 36-month change in BVA (p=0.004).
Conclusions :
While patients with IRF presented with lower baseline BVA, nAMD patients experienced similar 24- and 36-month changes in BVA regardless of fluid subtype or presence of ERF. This suggests that patients with nAMD are likely to experience similar long-term improvements in BVA regardless of fluid response to treatment at 12 weeks.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.