Anti-VEGF treatment for wet AMD generally aims to deactivate choroidal neovascularization lesions with the least number of injections; however, recent studies suggest some level of fluid may be tolerable and even beneficial. Delving further into this, new research published in Retina found that wet AMD eyes with persistent subretinal fluid achieved good outcomes that were similar to mostly inactive eyes at one year.

The international research team also observed worse visual outcomes in eyes with intraretinal fluid, which they say highlights the importance of distinguishing between intraretinal and subretinal fluid when managing AMD.

The study enrolled 703 treatment-naïve eyes. At each visit, the researchers graded lesion activity as inactive or active and noted the location of the fluid. They grouped eyes based on initial and predominant activity over 12 months.

At baseline, the active eyes with fluid extending beyond the subretina had a similar VA change as the active eyes with subretinal fluid only (5.7 vs. 6.9 letters); however, the former group’s final VA at 12 months was significantly worse (62.5 vs. 67.5 letters). The 12-month VA change between the active groups was also significantly different, with inactive eyes (7.6 letters) and active eyes with subretinal fluid only (7.5 letters) netting better results than those with fluid in multiple locations (3.6 letters).

Currently, there is no evidence, apart from clinical trials, that distinguishes the effects of subretinal and intraretinal fluids, the researchers noted. Previous research reported an increased risk of macular atrophy when lesions were predominantly dry and of subretinal fibrosis when lesions were predominantly active.

The current study’s results provide further evidence that tolerating subretinal fluid is compatible with good visual outcomes, at least in the short-term, the investigators suggested.

Nguyen V, Puzo M, Sanchez-Monroy J, et al. Association between anatomical and clinical outcomes of neovascular age-related macular degeneration treated with anti-VEGF. Retina. December 14, 2020. [Epub ahead of print].