Abstract
Purpose :
The aim of this study was to investigate the impact of retinal hemorrhages secondary to neovascular age-related macular degeneration (nAMD) activity on visual acuity (VA) and fluid volumes at the time of retinal hemorrhage occurrence and one month after anti-VEGF treatment.
Methods :
Consecutive eyes with active nAMD were prospectively imaged using optical coherence tomography (OCT) and color fundus photography (CFP). CFP was graded for retinal hemorrhages. Eyes with hemorrhages were compared to eyes without hemorrhages. Eyes were stratified by treatment status (naïve vs. pre-treated) and presence of hemorrhages. Subretinal fluid (SRF), intraretinal fluid (IRF) and pigment epithelium detachment (PED) volumes (in nL) were quantified in the central one mm and 1-6mm ring at baseline (BSL) and after one month of follow-up in OCT volumes using a validated AI-based algorithm (Vienna Fluid Monitor Version 2, RetInSight, Austria). Fluid volumes, VA at BSL, fluid resolution and VA change after one month of follow-up were compared using fixed effect models. All eyes were treated with anti-VEGF (aflibercept) at BSL.
Results :
One hundred sixty-seven eyes from 167 patients were included in this study. Thirty-two eyes (19.2%) presented with retinal hemorrhage at BSL. Eyes with hemorrhage had worse mean VA compared to eyes without hemorrhages (p=0.016, 68.4 letters, 95%CI:64.5–72.2 and 73.5 letters, 95%CI:71.9-75.2 with and without hemorrhage, respectively). Pre-treated eyes presented with higher SRF volumes in the central 1mm in comparison to treatment-naïve eyes and with greater SRF reduction in the central 1mm after one month. (SRF mean volume 1mm: pre-treated: 41.33nL, 95%CI:29.60–53.06, naïve: 17.06nL, 95%CI:9.55–24.56, p<0.001; mean SRF reduction central 1mm: pre-treated: 33.9nL, 95%CI:22.81–44.98, p=0.001, mean SRF reduction naïve: 11.57nL, 95%CI:4.37-18.78). Retinal hemorrhages did not show significant impacts on fluid volumes (p>0.05).
Conclusions :
Retinal hemorrhages in nAMD have a negative impact on macular function, but do not interfere with fluid volumes and fluid resolution. AI-based fluid quantifications on OCT are helpful to precisely evaluate disease activity to improve outcomes in the real world and are not compromised by retinal hemorrhage visible clinically.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.