First Author: E.Cervera Taulet SPAIN
Co Author(s): V. Castro Navarro C. Navarro-Palop J. Montero-Hernandez C. Monferrer-Adsuara
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Intraretinal cystoid fluid (IRC) is on of the most important predictive factor for baseline visual acuity and visual gains. IRC is a hallmark of type 2 and 3 lesions as well as a sign of chronic type 1; and seems to be sign of a more aggressive lesion type. IRC is a biomarker exquisitely responsive to antivascular-endothelial-growth-factor treatment; however, little is known about changes in its frequency among different subtypes of choroidal neovascularization (CNV) with a treat-and-extend (TAE) approach. Our objective is to investigate changes in the presence of IRC in different subtypes of CNV treated with a TAE regimen.
Retrospective nonrandomized cohort study. Thirty-seven eyes of patients with exudative AMD; 11 classic CNV, 12 occult CNV, 7 mixed CNV and 8 retinal angiomatous proliferations (RAP) lesions were analyzed.
Patients were treated with three monthly 2 mg aflibercept injections followed by a TAE regimen. According the multimodal in vivo imaging classification proposed by Freund and build on Donald Gass’ histologic classification, the study group was divided into four subgroups according to the : a) type 1 CNV, b) type 2 CNV c) a mixed typical subfoveal choroidal membrane lesions and d) the RAP group. Main outcome measures included changes in best-corrected-visual acuity (BCVA) and quantitative analysis with Spectral-domain optical coherence tomography (SD-OCT) of IRC in each subtype of CNV was recorded at baseline, at 3 months, at 6 months and at 12 months. IRC was considered as the presence of relatively large circular or ovoid spaces often associated with pigment epithelial detachments or neovascular tissue, and in the absence of retinal pigment epithelium atrophy or scarring. Statistical significance was defined as (p<0.05).
Patients received a mean of 7.89±1.22 aflibercept injections. Regarding functional outcomes, BCVA significantly improved 0.60 ± 0.27 LogMAR to 0.40 ± 0.34 LogMAR. Baseline percentage of presence of IRC in each subtype of CNV was 33.3% in type 1 CNV, 63.3% in type 2 CNV, 83.3% in mixed CNV and 75% in RAP. The presence of IRF mostly disappeared in all lesions after loading-dose ( 0% in type 1 CNV, 9% in type 2 CNV, 0% in mixed lesions and 25% in RAP); and persisted at low levels at deadline in all the subtypes. At 12 months evaluation it was found in 0% in type 1 CNV, 9% in type 2 CNV, 33.3% in mixed CNV and 0% in RAP.
In our study, baseline prevalence rate of IRC ranged from 33.3% in type 1 CNV to 83.3% in mixed lesions. Its presence clearly decreases after loading-dose in all subtypes of CNV and a TAE approach seems to be effective for maintaining this biomarker at low frequencies in all lesions. At deadline, it was more frequent in mixed CNV than in the rest of the subtypes.