Because of the importance of fluid status on treatment outcomes for patients with wet AMD, researchers decided to evaluate the effect on visual and anatomical outcomes of the type of fluid present at baseline and the loading phase of anti-VEGF treatment. They also assessed the effect of fluid status on the clinical results obtained with three treatment regimens—treat-and-extend (T&E), fixed bimonthly (FBM) injections and PRN dosing.

In this post hoc analysis of the In-Eye study, 270 patients were randomized 1:1:1 to receive one of the three treatment regimens, analyzing intraretinal fluid (IRF) and subretinal fluid (SRF), as well as the anatomical and visual outcomes. The study included 14 to 15 visits, depending on the treatment regimen.

Patients with SRF at the loading phase had better visual outcomes than patients with IRF. The persistence of SRF did not affect the mean change from baseline BCVA among the three treatment regimens. However, in patients with IRF, mean change from baseline acuity was significantly lower in the FBM group. The presence of IRF at baseline and at the end of the LP was associated with the development of fibrosis at the end of the study; this result was contrary to that observed in patients with SRF. This was one of the most relevant findings to the researchers, because to their best of their knowledge, it’s the first study to describe this “protective association.” The authors also observed that both the presence of atrophy and fibrosis are associated with a worse visual result.

While subretinal fluid is compatible with good visual and anatomical outcomes, the study concludes that the intraretinal variety leads to worse results in patients with neovascular AMD and is associated with a higher risk of atrophy and fibrosis. This suggests that patients with IRF have better outcomes when individualized treatment regimens are used in contrast with an FBM regimen.

“While patients with dry macula or SRF achieved better visual outcomes regardless of the treatment regimen, patients with persistent IRF had worse vision gains, especially when treated with FB injections of ranibizumab,” the authors noted in their study.

Saenz-de-Viteri M, Recalde S, Fernandez-Robredo P, et al. Role of intraretinal and subretinal fluid of clinical and anatomical outcomes in patients with neovascular age-related macular degeneration treated with bimonthly, treat-and-extend and as-needed ranibizumab in the In-Eye study. Acta Ophthalmol. doi: 10.1111/aos.14786