First Author: P.Tranos GREECE
Co Author(s): M. Triantafylla E. Vounotrypidis A. Vakalis S. Asteriadis N. Kozeis
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To assess the natural course of asymptomatic AMD which exhibits early signs of exudative conversion on imaging. In addition, to identify risk factors which are associated with visual deterioration and requirement for anti-VEGF treatment.
''Ophthalmica'' Institute of Ophthalmology and Microsurgery, Thessaloniki, Greece
Prospective, observational study of asymptomatic patients with dry AMD who developed minimal subretinal fluid (SRF) and/or intraretinal fluid (IRF) in conjunction with absence of active fluorescein leakage on fundus fluorescein angiography (FFA). All patients underwent best corrected visual acuity (BCVA) measurement, colour photo, FFA and spectralis OCT at baseline and completed at least 6 months of follow up. Primary outcome measure was the percentage of eyes progressing to active wet AMD within the follow up period.
Eighteen eyes of 15 patients who fulfilled the inclusion criteria were included in the study. The distribution of baseline OCT findings was: minimal SRF (6 eyes), minimal IRF (3 eyes), pigment epithelial detachment (PED) combined with minimal IRF (2 eyes), PED combined with minimal SRF (7 eyes). Two (11%) eyes developed signs of active disease within the follow up period and underwent intravitreal anti-VEGF injections. The interval between baseline and onset of active, wet AMD was 8 months in one eye and 18 months in the second. Mean (SD) baseline BCVA for the study eyes was 0.21(0.22) improving to 0.16 (0.19) at final follow up. The corresponding BCVA for the non treated eyes was 0.22 (0.23) at baseline and 0.15 (0.18) at final follow up (p=0.012). Final BCVA was associated with greater baseline BCVA (p<0.001), and thinner final central retinal thickness (CRT) (p=0.04).
The natural course of asymptomatic AMD which exhibits minimal signs of exudative conversion on OCT is favorable in the majority of cases. Clinicians might consider of adopting a more conservative approach towards such cases, refraining from performing intravitreal anti-VEGF injections provided frequent follow up is ensured.