Non-neovascular fluid in age-related macular degeneration: observe-and-extend regimen in a case-series study

Santina, Ahmad; Romero-Morales, Verónica; Abraham, Neda; Somisetty, Swathi; Levin, Miri Fogel; Bousquet, Elodie; Nudleman, Eric; Sadda, Srinivas R.; Sarraf, David

doi:10.1016/j.jcjo.2022.08.005

Cited by 4 publications

(8 citation statements)

References 23 publications

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“…In an eye with suspected nonneovascular SRF, the absence of macular neovascularization (MNV) with OCTA can prevent unnecessary anti-VEGF injection treatments. 12…”

Section: Nonneovascular Subretinal Fluid As a Results Of Retinal Pigm...mentioning

confidence: 99%

“…Subretinal fluid can also complicate nonneovascular AMD 9,10,12,13 and like IRF can be the result of degenerative mechanisms such as RPE impairment. Hilely et al 10 showed that large drusen and drusenoid pigment epithelial detachment (PED) can be associated with nonneovascular SRF and suggest that RPE pump dysfunction may explain this mechanism of fluid development.…”

Section: Nonneovascular Subretinal Fluid As a Results Of Retinal Pigm...mentioning

confidence: 99%

“…Associated findings of neovascular activity, such as heme and SHRM, and the presence of a multilayered or fibrovascular PED should be excluded before the diagnosis of nonneovascular fluid. 10,12,13 Progression of fluid or an enlarging PED are additional signs of neovascular activity. Degenerative IRF can be detected in the presence or absence of neovascularization because macular atrophy can occur in either setting.…”

Section: Evaluation and Management Of Nonneovascular Fluidmentioning

confidence: 99%

“…Santina et al 12 recently proposed an “observe-and-extend protocol for the management of nonneovascular SRF in eyes with intermediate AMD and noted stable or improved fluid with progressively longer intervals of observation. In the observe-and-extend protocol, interval extension is increased by 2 to 4 weeks only if fluid remains stable and in the absence of associated features of MNV such as heme or SHRM or progressive PED and without MNV detection with OCTA at every visit.…”

Section: Evaluation and Management Of Nonneovascular Fluidmentioning

confidence: 99%

“…However, recent studies have provided insight into the various nonneovascular pathways of exudation in eyes with AMD and indicate that fluid can have a much more complex and nuanced etiology and is not always an indicator of neovascular activity in AMD. [9][10][11][12][13][14] Although some have labelled nonneovascular fluid as a transudate and neovascular fluid as an exudate, 11,13 the mechanisms may be more complicated, and therefore, any form of fluid leakage (neovascular or nonneovascular) is best referred to as exudation. The subsequent sections of this editorial will summarize the various nonneovascular pathways of exudation (examples of exudation include IRF, SRF, and/or vitelliform lesions) in AMD and will provide guidelines for the diagnosis and management of nonneovascular fluid.…”

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confidence: 99%

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Pathways of Fluid Leakage in Age Related Macular Degeneration

Fouad

Santina

Bousquet

et al. 2023

Retina

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Age-related macular degeneration (AMD) represents a massive burden of vision impairment and blindness in the United States and worldwide, 1 but the management of this devastating disease has remarkably progressed because of the development of advanced retinal imaging tools, especially highresolution, depth-resolved optical coherence tomography (OCT) and OCT angiography (OCTA). Currently recognized OCT biomarkers for neovascular activity include intraretinal fluid (IRF), subretinal fluid (SRF), subretinal pigment epithelium fluid, and subretinal hyperreflective material (SHRM), which are critical factors guiding therapy. [2][3][4] Fluid is a major hallmark of exudation and angiogenic activity in eyes with neovascular AMD, indicating the need for treatment with anti-vascular endothelial growth factor (VEGF) injection. 2,3,5 A long list of pivotal clinical trials essential for the ratification and approval of various anti-VEGF therapies, including aflibercept, 6 brolucizumab, 7 and faricimab, 8 relied on the OCT response of anatomical biomarkers of neovascular activity to corroborate the observed functional efficacy of the investigated agent. In all cases, the study drug was no less effective or was better in resolving fluid markers such as IRF and SRF, and these OCT outcomes were critical factors that were evaluated to determine the treatment effect of the anti-VEGF agent. Fluid as a marker of neovascular activity is a universal concept that is essential for clin-

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“…In an eye with suspected nonneovascular SRF, the absence of macular neovascularization (MNV) with OCTA can prevent unnecessary anti-VEGF injection treatments. 12…”

Section: Nonneovascular Subretinal Fluid As a Results Of Retinal Pigm...mentioning

confidence: 99%