What are the risk factors of subretinal fibrosis in nAMD eyes?

In patients with neovascular age-related macular degeneration (nAMD), the presence of intraretinal fluid (IRF) and subretinal hyper-reflective material (SHRM) seem to increase the likelihood of subretinal fibrosis (SF), a recent study has found.

Forty-five treatment-naïve nAMD participants (n=45 eyes; mean age 77 years, 64 percent women) participated in the study. SF was detected using spectral-domain optical coherence tomography (SD-OCT), colour fundus photography, and fluorescein angiography 1 year after baseline.

Over 12 months of follow-up and an average of 8.3 intravitreal aflibercept injections, eight eyes developed SF (incidence rate, 18 percent). Age (p=0.76), sex (p=0.23), or the number of injections delivered (p=0.29) did not differ between the SF and non-SF participants.

On the other hand, eyes with SF had significantly worse best-corrected visual acuity (BCVA) at baseline (median, 54 vs 74 ETDRS letter score; p=0.001). Moreover, baseline IRF was significantly more common among SF eyes (100 percent vs 51 percent; p=0.014), as was SHRM (100 percent vs 54 percent; p=0.017).

In contrast, type 1 macular neovascularization (MNV; 70 percent vs 0 percent; p<0.001) was significantly more common in eyes without SF, while mixed-type MNV showed the opposite trend (63 percent vs 0 percent; p<0.001).

“The presence of a subretinal MNV component, IRF, and SHRM on SD-OCT and low baseline BCVA … are easily identifiable parameters indicating an increased risk and warranting close follow-up and intensified antivascular endothelial growth factor therapy,” the researchers said.