Abstract
Objective
To describe the course of non-neovascular fluid in age-related macular degeneration
(AMD) after anti–vascular endothelial growth factor (anti-VEGF) therapy or after observation
without injections.
Design
Retrospective case series.
Methods
AMD eyes with macular drusen and (or) drusenoid pigment epithelial detachment associated
with non-neovascular fluid were included. Optical coherence tomography (OCT) angiography
was performed in all eyes to exclude the presence of macular neovascularization. Subretinal
fluid (SRF) was measured to determine the response after anti-VEGF therapy and after
observation without injections.
Results
Ten eyes of 9 patients with intermediate AMD and SRF were studied over a median period
of 59.5 months (range, 7–128 months). Six patients (6 eyes) had a history of anti-VEGF
therapy. Median follow-up off injections was 13.5 months (range, 4–44 months). SRF
thickness remained stable and unchanged during the follow-up off injections in all
eyes (n = 6) with prior injection and in all eyes (n = 4) that had never been injected.
Six eyes developed complete retinal pigment epithelial (RPE) and outer retinal atrophy,
and 1 eye developed incomplete RPE and outer retinal atrophy. All eyes exhibited at
least 2 OCT biomarkers associated with a high risk for progression to atrophy.
Conclusion
This study provides preliminary data regarding the progression of non-neovascular
fluid in AMD with or without anti-VEGF injections. A possible mechanism for fluid
development may be related to RPE pump impairment. Distinguishing neovascular versus
non-neovascular fluid using multimodal imaging, including OCT angiography, is essential
to avoid unnecessary anti-VEGF therapy. An observe-and-extend regimen may be considered
in AMD eyes with non-neovascular fluid.
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Article info
Publication history
Published online: September 12, 2022
Accepted:
August 18,
2022
Received in revised form:
August 2,
2022
Received:
June 8,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
Published by Elsevier Inc. on behalf of Canadian Ophthalmological Society.
