Pathways of Fluid Leakage in Age Related Macular Degeneration

Abstract

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-

Characteristics Predictive of Fellow-Eye Geographic Atrophy without Neovascularization in Unilateral Type 3 Macular Neovascularization

“…4 In a more recent study by Wykoff et al, 7 which investigated the characteristics and risk factors of this event, baseline neovascular AMD in the contralateral eye and the presence of a double-layer sign were associated with an increased risk of developing neovascular AMD. Although it is necessary to conduct further evaluation to determine whether the exudation occurring during pegcetacoplan treatment actually originates from neovascular tissue or not, 30 it is crucial to take this into consideration when using the agent in practice.…”

Fixed Quarterly Dosing of Aflibercept after Loading Doses in Neovascular Age-Related Macular Degeneration in Chinese Eyes

“…The strict inclusion criteria also mean that this only represented a small proportion of all the injections performed at our institution in the study period. Recent evidence also suggested the use of optical coherence tomography angiography (OCT-A) as a non-invasive technique for detecting macular neovascularisation cases with persistent fluid [ 14 ]. We acknowledge the lack of use of such imaging modality in our cases during the study period.…”

“…new macular haemorrhage, neovascularisation, and/or an increase in OCT biomarkers for neovascular activity, and thus a decision for rescue treatment with shorter treatment intervals. The widely recognized OCT biomarkers for neovascular activity, including intraretinal fluid, subretinal fluid, subretinal pigment epithelium fluid, and subretinal hyperreflective material, were used when supplementing the clinical findings with OCT response [ 14 , 15 , 16 , 17 ].…”

Wide-Field Choroidal Thickness Analysis after Half-Fluence Photodynamic Therapy Combined with Intravitreal Aflibercept Injection in Pachychoroid Neovasculopathy

“…While CSC is associated with pachychoroid-driven leakage through the breakdown of the retinal pigment epithelium (RPE) barrier, similar choroidal pathology may also lead to the development of MNV [ 8 ]. PNV is associated with MNV; however, its clinical manifestations and genetic features are largely different from those of neovascular age-related macular degeneration (AMD) [ 9 , 10 , 11 ].…”