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  • Relationship of Vision to Retinal Fluid in Ranibizumab-Treated Neovascular AMD

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, January 2022

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    Evidence from recent studies has raised questions about using subretinal fluid (SRF) and/or intraretinal fluid (IRF) as biomarkers of disease activity in neovascular age-related macular degeneration (AMD), as well as the goal of achieving fluid-free retinas with anti-VEGF therapy. In a post hoc analysis of HARBOR data, Holekamp et al. explored the relationship between vision and retinal fluid in patients with neovascular disease treated by ranibizumab. They found that eyes with re­sidual SRF alone had the highest mean best-corrected visual acuity (BCVA) and the greatest change in BCVA by 12 and 24 months of as-needed or monthly ranibizumab treatment. Eyes with residual IRF alone had the poorest visual outcomes.

    For this analysis, the authors reviewed data for 917 participants of the phase 3, multicenter, randomized, controlled HARBOR trial. Patients were at least 50 years old, had subfoveal neovascular AMD associated with SRF and/or IRF (at baseline, screening, or week 1), and were treated with intravitreal ranibizumab .5 or 2.0 mg. Data for treatment arms were pooled. Mean BCVA and the change from baseline to months 12 and 24 were determined by fluid outcomes (e.g., the presence or absence of SRF and/or IRF).

    At 12 months, BCVA was better in patients with residual SRF than in those with resolved SRF (mean, 58.8 vs. 53.5 letters, respectively). Results at 24 months were similar (mean, 59.3 vs. 53.5 letters, respectively). The adjusted mean change in BCVA by month 12 was greater with residual SRF than with resolved SRF (mean difference of +2.4 letters), but it was lower with residual IRF versus resolved IRF (‒3.5 letters). The assessment of BCVA changes by fluid group at 12 and 24 months showed that eyes with residual SRF alone had the greatest gains in acuity (+14.1 letters at 12 months and +13.2 letters at 24 months). The respective gains were +10.6 and +10.0 letters for patients with dry retina; +7.2 and +8.5 letters for patients with SRF/IRF; and +5.5 and +3.6 letters for those with IRF only.

    The odds ratio of attaining visual acuity of 20/40 or better was similar for patients with residual and resolved SRF but was significantly worse with residual versus resolved IRF.

    These findings indicate that visual outcomes are affected by the presence/ absence and type of residual retinal fluid observed during ranibizumab treatment. Eyes with only residual SRF fared better than eyes with only residu­al IRF. Intraretinal fluid may not always be harmful to patients with neovascu­lar AMD, said the authors, as long as anti-VEGF treatment is given regularly. They acknowledged that more studies are needed to assess the long-term effects of intraretinal fluid and to refine strategies for managing neovascular disease.

    The original article can be found here.