Author: Jae Hui Kim (Korea, Republic of)
Co-authors: Jae Hui Kim, Min Sagong, Se Joon Woo, Yu Cheol Kim, Youkyung Lee, Se Woong Kang
Purpose
To evaluate presence of retinal fluid and the association of fluid-free period with visual outcome in patients with neovascular age-related macular degeneration (nAMD) who were treated with anti-vascular endothelial growth factor (VEGF)
Setting/Venue
Retrospective, multi-institutional study
Methods
This study included nAMD patients who were treated with ranibizumab, aflibercept, or bevacizumab at least 12 months after diagnosis. The presence of any retinal fluid, intraretinal fluid(IRF), subretinal fluid(SRF), and sub-retinal pigment epithelial(RPE) fluid at diagnosis and at 12 months was evaluated. Patients were divided into quartiles based on time with absence of fluid over 12 months and difference in the improvement in visual acuity (VA) was compared among the following three quartile groups: Q1 vs Q2-Q3 vs Q4.
Results
A total of 600 patients were included. During the 12 months, mean 5.54 anti-VEGF injections were administered. The mean baseline VA and central subfield thickness (CST) was 54.14 ± 20.69 (SD) ETDRS (Early Treatment of Diabetic Retinopathy Study) letters and 379.75 ± 135.15 (SD) µm. At 12 months, mean 8.91 ± 17.22(SD) letters of improvement in VA and mean 106.9 ± 136.68(SD) µm of decrease in CST was noted. At diagnosis, the incidence of any retinal fluid, IRF, SRF, and sub-RPE fluid was 97.16%, 39.97%, 90.13%, and 32.44%, respectively. At 12 months, the incidence was decreased to 58.1%, 24.66%, 37.59%, and 21.21%, respectively. The mean fluid-free period was 67.30 ± 92.54(SD) days. When divided into quartiles based on time with absence of fluid, the mean improvement in VA was +10.93 ± 17.96 (SD) letters in Q4 (25% of the patients with the longest fluid-free time), +10.10 ± 17.24 (SD) letters in Q2-Q3, and +5.56 ± 16.17 (SD) letters in Q1 (25% of the patients with the shortest fluid-free period). When compared to Q1, greater improvement in VA was noted in Q2-Q3(P=0.0038) and Q4(P=0.0004).
Conlusions
Result of the present study suggests that appropriate fluid control is important to achieve good visual outcomes. However, retinal fluid was noted in approximately two-thirds of the nAMD patients even after anti-VEGF therapy, suggesting the unmet needs in clinical practice.
Financial Disclosure
This study was supported by Novartis Korea, Ltd.
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