Retinal fluid volume variations during anti-VEGF maintenance therapy tied to worse VA

Among patients with neovascular age-related macular degeneration (nAMD), fluctuations in retinal fluid volume during the maintenance phase antivascular endothelial growth factor (anti-VEGF) therapy may lead to long-term deterioration in visual acuity (VA), a recent study has found.

Researchers retrieved medical data from 381 nAMD patients (403 eyes; mean age 77.8±6.8 years, 63.0 percent women) with baseline VA of ≥33 and ≤73 letters, and with at least two available optical coherence tomography (OCT) measurements. An artificial intelligence algorithm was used to analyse the OCT scans and quantify the volumes of the intraretinal (IRF), subretinal (SRF), and total (TF) fluids, along with other relevant parameters.

Participants were grouped according to quartiles of the standard deviation (SD) in IRF, SRF, TF, pigment epithelial detachment (PED), and central subfield thickness (CSFT) to assess the impacts of variations in these parameters on VA.

Generalized estimating equation models showed that at 24 months, patients belonging to the topmost vs bottom quartile of retinal fluid variation had worse VA. For instance, those in quartile 4 vs 1 of TF SD saw a loss of 9.4 letters (95 percent confidence interval [CI], –12.9 to –6.0).

Moreover, those in the topmost SD quartile of IRF and SRF saw VA losses of 7.38 (95 percent CI, –11.06 to –3.66) and 5.00 (95 percent CI, –8.45 to –1.55) letters, respectively.

Similar patterns of effect were reported for PED (Q4 vs Q1: coefficient, –6.44, 95 percent CI, –10.05 to –2.83) and CSFT (Q4 vs Q1: coefficient, –7.75, 95 percent CI, –11.46 to –4.05). Across all OCT parameters tested, higher SD values correlated with worse VA outcomes.