Association Between Anatomical and Clinical Outcomes of Neovascular Age-Related Macular Degeneration Treated With Antivascular Endothelial Growth Factor

Nguyen, Vuong; Puzo, Martin; Sánchez‐Monroy, Jorge; Gabrielle, Pierre‐Henry; Garcher, Catherine Creuzot; Baudin, Florian; Wolff, Benjamin; Castelnovo, Laurent; Michel, Guillaume; O'Toole, Louise; Barthelmes, Daniel; Gillies, Mark C

doi:10.1097/iae.0000000000003061

Cited by 4 publications

(10 citation statements)

References 28 publications

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“…Conversely, mostly onlySRFL eyes had better VA at 5 years (63.7 letters), comparable with mostly inactive eyes (63.7 letters), and a higher proportion of eyes with VA ≥70 letters (51%). These data are consistent with other studies regarding the tolerability of SRFL in terms of VA (Chaudhary et al, 2022;Grunwald et al, 2017;Guymer et al, 2019;Nguyen et al, 2021;Zarbin et al, 2021).…”

Section: Discussionsupporting

confidence: 93%

Subretinal fluid may protect against macular atrophy in neovascular age‐related macular degeneration: 5 years of follow‐up from Fight Retinal Blindness registry

Sánchez‐Monroy

Nguyen

Puzo

et al. 2022

Acta Ophthalmologica

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Purpose The purpose of the study was to assess the association of macular atrophy (MA) according to the activity of macular neovascularization (MNV) (inactive, only subretinal fluid [SRFL], or active, i.e. including intraretinal fluid [IRFL]) using optical coherence tomography (OCT) in patients with neovascular age‐related macular degeneration (nAMD). Methods Multicentric observational study. Treatment‐naïve nAMD eyes without subfoveal MA or subretinal fibrosis (SF) at baseline were included since 1st January 2010 and 30th September 2016 to allow up to 5 years of treatment follow‐up. Eyes were grouped based on their predominant activity status as: (1) mostly inactive, (2) mostly active non‐SRFL only [IRFL] or (3) mostly active‐SRFL only [onlySRFL]. Kaplan–Meier survival curves estimated the time to development of MA or SF. Cox proportional hazards models evaluated predictors of developing subfoveal MA or SF. The main outcome measure was the risk of developing MA according to predominant MNV activity. Results A total of 973 eyes were eligible for analysis. OnlySRFL eyes had lower risk of developing subfoveal MA (HR [95% CI]: 0.56 [0.36, 0.88]; p = 0.024) and extrafoveal MA (HR [95% CI]: 0.41 [0.27, 0.61]; p < 0.001) than IRFL eyes. IRFL eyes had lower visual acuity (VA) (54.5 letters) and the highest proportion of eyes with vision ≤35 letters (25%) at 5 years while onlySRFL eyes had comparable 5‐year VA (63.7 letters) to inactive eyes (63.7 letters). Conclusion Subretinal fluid appears to protect against MA. Distinguishing the compartment of retinal fluid and understanding its relationship with MA and SF can guide the management of nAMD.

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Section: Discussionsupporting

confidence: 93%

Subretinal fluid may protect against macular atrophy in neovascular age‐related macular degeneration: 5 years of follow‐up from Fight Retinal Blindness registry

Sánchez‐Monroy

Nguyen

Puzo

et al. 2022

Acta Ophthalmologica

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“…However, a recent systematic review has demonstrated that after adjusting for the number of intravitreal anti-VEGF injections, neither the treatment dosing regimen adopted, nor the anti-VEGF agent used, were significant predictors for visual acuity changes [ 13 ]. Nonetheless, other factors such as age, anatomical status of the retina, including the presence or absence of subretinal and/or intraretinal fluids, optical coherence tomography (OCT) central macular thickness, and macular morphology have been implicated as important prognostic factors in determining visual outcomes [ 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

Lai

Lai²

2021

JPM

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Previous studies based on clinical trial data have demonstrated that greater fluctuations in retinal thickness during the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) is associated with poorer visual acuity outcomes. However, it was unclear whether similar findings would be observed in real-world clinical settings. This study aimed to evaluate the association between retinal thickness variability and visual outcomes in eyes receiving anti-VEGF therapy for nAMD using pro re nata treatment regimen. A total of 64 eyes which received intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept) for the treatment of nAMD were evaluated. Variability in spectral-domain optical coherence tomography (OCT) central subfield thickness (CST) was calculated from the standard deviation (SD) values of all follow-up visits after three loading doses from month 3 to month 24. Eyes were divided into quartiles based on the OCT CST variability values and the mean best-corrected visual acuity values at 2 years were compared. At baseline, the mean ± SD logMAR visual acuity and CST were 0.59 ± 0.39 and 364 ± 113 µm, respectively. A significant correlation was found between CST variability and visual acuity at 2 years (Spearman’s ρ = 0.54, p < 0.0001), indicating that eyes with lower CST variability had better visual acuity at 2 years. Eyes with the least CST variability were associated with the highest mean visual acuity improvement at 2 years (quartile 1: +9.7 letters, quartile 2: +1.1 letters, quartile 3: −2.5 letters, quartile 4: −9.5 letters; p = 0.018). No significant difference in the number of anti-VEGF injections was found between the four CST variability quartile groups (p = 0.21). These findings showed that eyes undergoing anti-VEGF therapy for nAMD with more stable OCT CST variability during the follow-up period were associated with better visual outcomes. Clinicians should consider adopting treatment strategies to reduce CST variability during the treatment course for nAMD.

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“…Post hoc analyses of clinical trials and real-world outcomes demonstrated that intraretinal fluid presence at baseline is associated with a worse visual prognosis [26,27]. Subretinal fluid at baseline does not affect the outcome but its fluctuation during the treatment course is associated with a poorer prognosis [27][28][29]. Differently from these two components, fluid located underneath the RPE has not been directly associated with visual outcomes although once again, the eyes with higher fluctuations have shown a trend towards a poorer vision [30].…”

Section: Discussionmentioning

confidence: 98%

“…The fluid may be identified at different levels such as intraretinal, subretinal, and sub-RPE. Post hoc analyses of clinical trials and real-world outcomes demonstrated that intraretinal fluid presence at baseline is associated with a worse visual prognosis [26,27]. Subretinal fluid at baseline does not affect the outcome but its fluctuation during the treatment course is associated with a poorer prognosis [27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Prechoroidal cleft thickness correlates with disease activity in neovascular age-related macular degeneration

Cozzi

Monteduro

Parrulli

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose The purpose of this study was to investigate the structural variations of the hyporeflective pocket of fluid (prechoroidal cleft) located between Bruch’s membrane and the hyperreflective material within the pigment epithelial detachment (PED) in patients with neovascular age-related macular degeneration (nAMD). Methods In this retrospective, observational case series study, patients diagnosed with nAMD and prechoroidal cleft associated with other activity signs of the macular neovascularization (MNV) were included. Structural optical coherence tomography (OCT) scans were evaluated to obtain anatomical measurements of prechoroidal cleft and PED at three different visits (T0, inactive MNV; T1, active MNV; T2, treated inactive MNV). The variations in size of the cleft and the PED were correlated with nAMD activity. Results Twenty-nine eyes from 27 patients were included. The subfoveal measurements showed a significant increase of prechoroidal cleft height and width from T0 to T1 (P < 0.05) and a subsequent decrease of the cleft height after treatment with anti-VEGF agents (P = 0.004). A similar significant trend was observed for the greatest prechoroidal cleft height and width, obtained assessing the whole OCT raster. In the multivariate analysis, the cleft height was significantly affected by both time (P = 0.001) and PED height (P < 0.0001). By contrast, the effect of fibrovascular tissue size within the PED was not significant. Visual acuity did not correlate with prechoroidal cleft size. Conclusion Prechoroidal cleft increased in association with MNV reactivation and decreased after treatment. Our results suggest that prechoroidal cleft could represent an accumulation of fluid actively exudating from the MNV and should be considered a sign of nAMD activity.

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Association Between Anatomical and Clinical Outcomes of Neovascular Age-Related Macular Degeneration Treated With Antivascular Endothelial Growth Factor

Abstract: Supplemental Digital Content is Available in the Text. Persistent subretinal fluid only in patients with neovascular age-related macular degeneration is compatible with good 12-month visual outcomes. Intraretinal fluid by contrast was associated with worse visual outcomes.

Cited by 4 publications

References 28 publications

Subretinal fluid may protect against macular atrophy in neovascular age‐related macular degeneration: 5 years of follow‐up from Fight Retinal Blindness registry

Subretinal fluid may protect against macular atrophy in neovascular age‐related macular degeneration: 5 years of follow‐up from Fight Retinal Blindness registry

Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

Prechoroidal cleft thickness correlates with disease activity in neovascular age-related macular degeneration

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