To assess the prognostic value of subretinal (SRF) and intraretinal fluid (IRF) localizations in type 1 macular neovascularization (MNV) due to age-related macular degeneration (AMD)
Name
Effet de la localisation initiale du fluide sur l’acuité visuelle et le pronostic des néovaisseaux maculaires de type 1 traités par anti-VEGF
Name
Effet de la localisation initiale du fluide sur l’acuité visuelle et le pronostic des néovaisseaux maculaires de type 1 traités par anti-VEGF
Orateurs :
Mr Etienne GADIOLLET
Résumé
Introduction
Matériels et Méthodes
This retrospective multicenter study included consecutive eyes treated with intravitreal injections of anti-VEGF for type 1 MNV due to AMD.
Résultats
At baseline 211 eyes were included and the mean best-corrected visual acuity (BCVA) was 66.2 letters. SRF was present in 94.8% of eyes, IRF in 30.8%, and both in 25.6%. Data were available for 201 eyes at 12 months, and 157 eyes at 24 months. The presence of IRF at baseline was associated with lower baseline BCVA and significantly lower BCVA at 12 months (p<0.001) and 24 months (p<0.001). Eyes with SRF alone displayed better visual outcomes (BCVA at month 12, SRF = 74.3 letters, IRF±SRF = 56.9 letters). In the presence of baseline IRF, fibrosis (p=0.03) and atrophy (p<0.001) were more frequently found at 24 months. There was no significant difference in the number of anti-VEGF injections according to fluid localization at 12 months (p=0.5), and 24 months (p=0.43).
Discussion
Our study highlight the worse functional outcomes in type 1 MNV with presence of IRF at baseline. Those results are consistent with large randomized controlled trials, which included all patients with neovascular AMD regardless of the MNV subtype. However, recent evidence from Shama et al and Sacconi et al demonstrated inverse correlation in type 3 MNV. As MNV1 are the most frequent MNV subtype and therefore the most frequently included in randomized trials, our study demonstrates that results of randomized trials including all MNV subtypes are mainly driven by type 1 MNV. These results highlight the need to evaluated fluid localization at baseline and during follow-up according to the anatomical classification of the causative MNV subtype.
Conclusion
In type 1 MNV, the presence of baseline IRF was associated with worse visual outcomes compared to SRF alone, and more frequent atrophy and fibrosis