| Summary: | Purpose: To assess the effect of clinical factors on the development and progression of
atrophy and fibrosis in patients with neovascular age-related macular degeneration
(nAMD) receiving long-term treatment in the real world.
Methods: An ambispective 36-month multicentre study, involving 359 nAMD patients from
17 Spanish hospitals treated according to the Spanish Vitreoretinal Society guidelines, was
designed. The influence of demographic and clinical factors, including the presence and
location of retinal fluid, on best-corrected visual acuity (BCVA) and progression to atrophy
and/or fibrosis were analysed.
Results: After 36 months of follow-up and an average of 13.8 antiVEGF intravitreal
injections, the average BCVA gain was +1.5 letters, and atrophy and/or fibrosis were
present in 54.8% of nAMD patients (OR=8.54, 95% CI=5.85-12.47, compared to baseline).
Atrophy was associated with basal intraretinal fluid (IRF) (OR=1.87, 95% CI=1.09-3.20),
whereas basal subretinal fluid (SRF) was associated with a lower rate of atrophy (OR=0.40,
95% CI=0.23-0.71) and its progression (OR=0.44, 95% CI=0.26-0.75), leading to a slow
progression rate (OR=0.34, 95% CI=0.14-0.83). Fibrosis development and progression were
related to IRF at any visit (p<0.001). In contrast, 36-month SRF was related to a lower rate
of fibrosis (OR=0.49, 95% CI=0.29-0.81) and its progression (OR=0.50, 95% CI=0.31-0.81).
Conclusion: Atrophy and/or fibrosis were present in 1 of 2 nAMD patients treated for 3
years. Both, especially fibrosis, lead to vision loss. SRF was associated with good visual
outcomes and lower rates of atrophy and fibrosis, whereas IRF yields worse visual results
and a higher risk of atrophy and especially fibrosis in routine clinical practice.
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