IRF cyst localization within different retinal layers may impact outcome of AMD-related macular neovascularization

A recent retrospective case series study delved into the relationship between intraretinal fluid (IRF) localization within retinal layers and the 2-year prognosis for patients with neovascular age-related macular degeneration (AMD). The findings unveiled critical insights into the predictive value of IRF localization for the visual and anatomical outcomes in this cohort.

This study was published in the journal Ophthalmology Retina by Alessandro Arrigo and colleagues. The study involved 243 eyes of AMD patients affected by type 1 and type 2 macular neovascularization (MNV). Optical coherence tomography (OCT) imaging was utilized to classify MNV types, identify various fluid types, and determine IRF localization within retinal layers. A subset of eyes was further analyzed using OCT angiography. The study assessed the association between IRF cyst localization and visual outcomes, particularly the onset of outer retinal atrophy, over a 2-year period.

  • Neovascularizations Breakdown: Type 1 MNV constituted 69%, while type 2 MNV accounted for 31% of cases.

  • Treatment Metrics: Patients received a mean of 7 ± 2 intravitreal injections at the 1-year mark and 5 ± 2 injections at the 2-year follow-up.

  • Visual Acuity: Baseline best-corrected visual acuity improved significantly from 0.4 ± 0.3 to 0.3 ± 0.4 logarithm of the minimum angle of resolution at the 2-year follow-up (P < 0.01).

  • Outer Retinal Atrophy: Occurrence rates were 24% at 1 year and increased to 39% at the 2-year follow-up.

  • IRF Localization Impact: IRF localized at the IPL–INL and OPL–ONL retinal layers at baseline correlated with the poorest functional and anatomical outcomes.

  • Vascular Network Impact: Presence of IRF at baseline was linked to greater impairment of the intraretinal vascular network.

The study concluded that IRF localization at specific retinal layers, particularly IPL–INL and OPL–ONL, serves as a critical prognostic marker for the long-term morphologic and functional outcomes in neovascular AMD patients. This identification offers clinicians a valuable predictive tool for better patient management and treatment planning.

Reference:

Arrigo, A., Aragona, E., Bianco, L., Antropoli, A., Berni, A., Saladino, A., Cosi, V., Bandello, F., & Battaglia Parodi, M. The localization of intraretinal cysts has a clinical role on the 2-year outcome of neovascular age-related macular degeneration. Ophthalmology Retina,2023;7(12):1069–1079. https://doi.org/10.1016/j.oret.2023.07.025

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