Session Title: AMD I
Session Date/Time: Friday 12/09/2014 | 08:00-10:00
Paper Time: 08:48
Venue: Boulevard C
First Author: : I.Mantel SWITZERLAND
Co Author(s): : C. Gianniou A. Dirani L. Jang A. Ambresin
Anti-VEGF treatment for neovascular age-related macular degeneration (nAMD) successfully improves visual acuity (VA) in a monthly treatment regimen or in individual dosing regimen. Treatment aims an exudation-free macula. However, in some patients a dry macula cannot be obtained despite maximal monthly retreatment. The aim of the present study was to investigate and compare the functional outcome of patients with treatment refractory intraretinal or subretinal fluid.
: retrospective chart review of a single institution (Department of ophthalmology, University of Lausanne, Jules Gonin Eye Hospital)
A consecutive series of patients with nAMD and treated with intravitreal ranibizumab was identified. Patients were included in this analysis if the treated eye never presented an exudation free macula on spectral domain optical coherence tomography (SD-OCT) at any visit (1 month after injection) during the first 12 months, motivating monthly retreatment. Data were collected for patients’ caracteristics, baseline ocular caracteristics, type of refractory fluid (intra- or subretinal), follow-up duration, number of injections, visual acuity over time, and time to the success of a dry macula. Outcome measures were the mean visual acuity change over time, the proportion of eyes with > 15 letters gain, > 0 letter gain, and < 15 letters loss, the comparison between the functional results of refractory subretinal versus refractory intraretinal fluid, and the Kaplan Meier Success curve for completely dry macula.
76 eyes of 74 patients (mean age 77.7 ± 9.4 years) were included. The mean number of injections was 11.43 ± 0.9 in the first year, and 27.7 ± 10.7 during the mean follow-up of 33.6 ± 14.9 months. The refractory fluid was located under the fovea in 61.8%. Complete absorption of the fluid was seen in 27 eyes (35.5%) after a mean of 21.8 months (range 13-49). Mean VA improvement was 9.0, 7.9, and 7.9 letters at 12, 24, and 36 months, respectively. The proportion of eyes with > 15 letters gain / < 15 letters loss was 30.3% / 97.4% and 26.7% / 90.0% at month 12 and 36, respectively. The comparison between the subgroups of refractory cysts (n=31), and refractory subretinal fluid (n=45) showed that eyes with refractory cysts started at a lower level of visual acuity (53.7 ±17.2 versus 65.3 ± 11.9 letters ETDRS, p=0.01), showed similar mean VA improvement, but had a higher risk to suffer from a 2 lines VA loss (Kaplan Meier curve, p=0.018). They were at higher risk to develop fibrosis (OR 3.30; CI 1.29-8.78, p=0.027) or atrophy (OR 3.34; CI 1.17-9.50, p=0.035).
Refractory intra- or subretinal fluid in nAMD is compatible with good functional outcome. However, refractory cysts show a significantly higher risk than subretinal fluid to suffer from visual acuity loss, fibrosis, and atrophy over time.