Abstract
Abstract
Objectives
To study the effect of repeated retinal thickness fluctuations during the anti-VEGF therapy maintenance phase in neovascular age-related macular degeneration (nAMD).
Methods
Data were extracted from electronic medical records of 381 nAMD patients, aged ≥50 years; baseline VA ≥33 and ≤73 letters; ≥24 months’ follow-up and ≥2 optical coherence tomography (OCT) measurements. OCT scans were analysed using an artificial intelligence algorithm that quantified the volumes of intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachments (PED) and central subfield thickness (CSFT). IRF, SRF and PED were summed to obtain total fluid (TF). The standard deviation (SD) of IRF, SRF, PED, CSFT and TF was computed and categorised into quartiles (SD-Q). Relationships between SD-Qs for each OCT feature and VA change was tested using generalised estimating equations and linear regression.
Results
By Month 24, compared to SD-Q1, eyes in SD-Q2, SD-Q3, and SD-Q4 for IRF, SRF, PED, CSFT and TF showed greater VA losses. Eyes in SD-Q4 of TF were 9.4 letters worse compared to eyes in Q1 (95% Confidence Interval: −12.9 to −6.0). The frequency of clinic visits with IRF and SRF present on OCT scans by quartiles of CSFT was lower in eyes with least fluctuation (Q1) compared to eyes with the most fluid fluctuation (Q4) (median [IQR] IRF: 0.3 [0.0–0.7] versus 0.8 [0.5–1.0]; SRF: 0.0 [0.0–0.5] versus 0.6 [0.3–1.0]).
Conclusions
Greater fluctuations in retinal fluid volumes during the maintenance phase of anti-VEGF treatment in nAMD is associated with worse VA by 2 years.
Publisher
Springer Science and Business Media LLC
Reference23 articles.
1. Wong TY, Chakravarthy U, Klein R, Mitchell P, Zlateva G, Buggage R, et al. The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology. 2008;115:116–26.
2. Samalia P, Garland D, Squirrell D. Nurse specialists for the administration of anti-vascular endothelial growth factor intravitreal injections. N Z Med J. 2016;129:32–38.
3. Engman SJ, Edwards AO, Bakri SJ. Administration of repeat intravitreal anti-VEGF drugs by retina specialists in an injection-only clinic for patients with exudative AMD: patient acceptance and safety. Semin Ophthalmol. 2011;26:380–6.
4. Alexandru MR, Alexandra NM. Wet age related macular degeneration management and follow-up. Rom J Ophthalmol. 2016;60:9–13.
5. Nguyen V, Daien V, Guymer R, Young S, Hunyor A, Fraser-Bell S, et al. Projection of long-term visual acuity outcomes based on initial treatment response in neovascular age-related macular degeneration. Ophthalmology. 2019;126:64–74.