Prolonged subretinal fluid linked to visual deterioration in AMD and PCV patients treated with aflibercept

In patients with neovascular age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV) undergoing aflibercept treatment, the presence of prolonged residual subretinal fluid (SRF) is associated with an increased risk of visual deterioration, according to a study that highlights that both the duration and mean height of persistent SRF significantly influence visual outcomes.

The study included 135 patients diagnosed with either neovascular AMD or PCV, who exhibited fovea-involving residual SRF persisting for a minimum of 6 months during aflibercept treatment.

Throughout the study, the duration of persistent SRF averaged at 17.1 ± 10.3 months, with a mean injection interval of 2.6 ± 0.7 months. Analysis of changes in best-corrected visual acuity (BCVA) during this period revealed a shift from 0.30 ± 0.23 (Snellen equivalents, 20/39) to 0.36 ± 0.28 (20/45). Notably, 18 patients (13.3%) experienced a visual deterioration of ≥2 lines.

The study found that the duration of persisting SRF (P = 0.008) and the mean height of SRF (P = 0.005) were closely associated with a heightened risk of visual deterioration. Among patients with a mean SRF height <100 μm, only 5.0% experienced visual deterioration, whereas among those with mean SRF heights ≥100 μm and <200 μm, and those ≥200 μm, the rates rose to 19.5% and 42.9%, respectively.

The findings underscore the importance of minimizing both the duration and mean height of persistent SRF in patients undergoing aflibercept treatment for neovascular AMD or PCV to mitigate the risk of visual deterioration.

Reference
Lee JH, Kim JH. Impact of Prolonged Persisting Subretinal Fluid on the Outcome of Aflibercept Treatment in Neovascular Age-Related Macular Degeneration. J Ocul Pharmacol Ther. 2024;40(2):136-143. doi: 10.1089/jop.2023.0124. Epub 2024 Jan 12. PMID: 38489060.