Connections found in subretinal fluid volatility, visual acuity outcomes
Subretinal fluid volatility may play a key role in predicting visual acuity outcomes of neovascular age-related macular degeneration, according to research presented at the virtual American Academy of Ophthalmology annual meeting.
Justis P. Ehlers, MD, of Cleveland Clinic, and colleagues enrolled 90 treatment naive patients comparing 2 mg of Eylea (aflibercept, Regeneron) with 6 mg Beovu (brolucizumab, Novartis) over 56 weeks.
“Trained expert readers validated the accuracy of the segmentation, each macular scan from baseline to week 56 was automatically segmented for each of these key features including fluid subretinal hyper reflective material, as well as the ellipsoid zone and retinal pigment epithelium,” Ehlers said in a recorded presentation.
General outcomes were based on development of subretinal hyperreflective material volume, ellipsoid zone integrity and visual acuity outcomes.
In results from week 12, hyperreflective material showed a statistically significant higher development of subretinal hyperreflective material in the high volatility group compared with the low volatility group. Ehlers reported that there was a mean change in data for hyperreflective material from week 12 in overall stability with minimal changes of fluid over time compared with high subretinal fluid volatility (n = 20) with progressive development of subretinal hyperreflective material. Investigators also observed decline in total attenuation and improvement in ellipsoid zone integrity in low volatility groups (n = 29), including subretinal fluid (n = 29), total macular/total retinal fluid index (n = 26) and central macular total retinal fluid index (n = 26) at week 12. However, intraretinal fluid volatility groups do not appear to diverge (n = 21).
“When we look at this, it's that ellipsoid zone to retinitis pigmentosa volume across the macular cube, we see similar trends with a generalized increase in volume in the low volatility groups with more variability in the high volatility groups,” Ehlers said.
The driving factor of these results is dynamic volatility of the subretinal fluid, as shown in result gaps between the high volatility and low volatility groups compared with intraretinal fluid groups, which showed negligible differences after week 56, according to Ehlers.
Data from machine learning analysis showed more volatility of subretinal fluid was associated with increases in subretinal hyperreflective material and reduced improvement in ellipsoid zone integrity, suggesting subretinal fluid volatility may be damaging to key anatomic traits associated with the visual outcomes in wet AMD.
“Greater volatility of subretinal fluid was associated with greater increase in subretinal hyperreflective material and reduce improvement in ellipsoid seven integrity,” Ehlers said.
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Ehlers, JP. RET16.05. Presented at: American Academy of Ophthalmology annual meeting; Nov.13-15, 2020 (virtual meeting).
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