Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jun 1;140(6):611-622.
doi: 10.1001/jamaophthalmol.2022.1357.

Association Between Visual Acuity and Residual Retinal Fluid Following Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-analysis

Nikhil S Patil  1 , Andrew Mihalache  2 , Arjan S Dhoot  3 , Marko M Popovic  4 , Rajeev H Muni  4   5 , Peter J Kertes  4   6
Affiliations
Meta-Analysis

Association Between Visual Acuity and Residual Retinal Fluid Following Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-analysis

Nikhil S Patil et al. JAMA Ophthalmol. .

Abstract

Importance: The association between residual subretinal fluid (SRF) and intraretinal fluid (IRF) and visual acuity following anti-vascular endothelial growth factor (VEGF) treatment is not well understood.

Objective: To examine the association of residual retinal fluid, SRF, and IRF with visual acuity following anti-VEGF treatment in patients with neovascular age-related macular degeneration (nAMD).

Data sources: A systematic literature search was performed from January 2005 to August 2021 using Ovid MEDLINE, Embase, and the Cochrane Library.

Study selection: Peer-reviewed articles reporting on visual acuity stratified by the presence or absence of any residual SRF, IRF, or any retinal fluid at last study observation after intravitreal bevacizumab, ranibizumab, aflibercept, or brolucizumab in patients with nAMD were included. Studies that were noncomparative, included fewer than 10 eyes, or reported on other anti-VEGF agents were excluded.

Data extraction and synthesis: Two independent reviewers conducted data extraction and synthesis. The Cochrane risk of bias tool 2 and ROBINS-I were used to assess risk of bias and GRADE evaluation was conducted to assess certainty of evidence.

Main outcomes and measures: Primary outcomes were BCVA at last study observation, change in BCVA from baseline, and retinal thickness at last study observation.

Results: In this systematic review and meta-analysis, 11 studies (6 randomized clinical trials [RCTs]) comprising 3092 eyes were included in our analysis. Across all included studies, the BCVA of eyes with residual SRF was better than eyes without SRF (weighted mean difference [WMD], 3.1 letter score; 95% CI, 0.05 to 6.18; P = .05; GRADE, low certainty of evidence; 6 studies; 1931 eyes) but similar in RCTs (WMD, 2.7 letter score; 95% CI, -2.40 to 7.84; P = .30; GRADE, low certainty of evidence; 3 studies; 1406 eyes). The BCVA of eyes with residual IRF was worse than that of eyes without IRF (WMD, -8.2 letter score; 95% CI, -11.79 to -4.50; P < .001; GRADE, low; 7 studies; 2114 eyes).

Conclusions and relevance: The findings suggest that the presence of residual SRF was associated with slightly better BCVA at last study observation; however, baseline differences in BCVA existed and this conclusion was primarily driven by 1 study. The presence of residual IRF was associated with substantially worse BCVA at last study observation and less improvement of BCVA from baseline. The conclusions are limited by the inclusion of data from observational studies, heterogeneity, and a low certainty of evidence.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Popovic reported grants from Physicians’ Services Incorporated Foundation outside the submitted work. Dr Muni reported grants from Bayer, Novartis, and Roche and personal fees from Bayer and Novartis outside the submitted work. Dr Kertes reported grants from Bayer, Novartis, Pfizer, Roche, and Zeiss; personal fees from Allergan, Bayer, Novartis, Novelty Nobility, and Roche; nonfinancial support from Bayer and Novartis; and equity in ArcticDx outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Forest Plots Depicting Presence vs Absence of Residual Subretinal Fluid (SRF) at Last Study Observation
Follow-up range: 3.6 to 24.0 months. Lines represent 95% CIs; diamonds, overall effect estimate of the meta-analysis; points, point estimates of individual studies. Retinal thickness was central subfield thickness, central retinal thickness, or central macular thickness. Optical coherence tomography parameters were determined using spectral-domain optical coherence tomography. BCVA indicates best-corrected visual acuity; IV, inverse variance.
Figure 2.
Figure 2.. Forest Plots Depicting Presence vs Absence of Residual Intraretinal Fluid (IRF) at Last Study Observation
Follow-up range: 3.6 to 24.0 months. Lines represent 95% CIs; diamonds, overall effect estimate of the meta-analysis; points, point estimates of individual studies. Retinal thickness was central subfield thickness, central retinal thickness, or central macular thickness. Optical coherence tomography parameters were determined using spectral-domain optical coherence tomography. BCVA indicates best-corrected visual acuity; IV, inverse variance.
Figure 3.
Figure 3.. Forest Plots Depicting Presence vs Absence of Residual Retinal Fluid at Last Study Observation
Follow-up range: 3.6 to 24.0 months. Lines represent 95% CIs; diamonds, overall effect estimate of the meta-analysis; points, point estimates of individual studies. Retinal thickness was central subfield thickness, central retinal thickness, or central macular thickness. Optical coherence tomography parameters were determined using spectral-domain optical coherence tomography. BCVA indicates best-corrected visual acuity; IV, inverse variance.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Yorston D. Anti-VEGF drugs in the prevention of blindness. Community Eye Health. 2014;27(87):44-46. - PMC - PubMed
    1. Virgili G, Parravano M, Evans JR, Gordon I, Lucenteforte E. Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis. Cochrane Database Syst Rev. 2018;10(10):CD007419. doi:10.1002/14651858.CD007419.pub6 - DOI - PMC - PubMed
    1. Rezar S, Eibenberger K, Bühl W, Georgopoulos M, Schmidt-Erfurth U, Sacu S; Macula Study Group Vienna . Anti-VEGF treatment in branch retinal vein occlusion: a real-world experience over 4 years. Acta Ophthalmol. 2015;93(8):719-725. doi:10.1111/aos.12772 - DOI - PubMed
    1. Qian T, Zhao M, Wan Y, Li M, Xu X. Comparison of the efficacy and safety of drug therapies for macular edema secondary to central retinal vein occlusion. BMJ Open. 2018;8(12):e022700. doi:10.1136/bmjopen-2018-022700 - DOI - PMC - PubMed
    1. Boyer DS, Hopkins JJ, Sorof J, Ehrlich JS. Anti-vascular endothelial growth factor therapy for diabetic macular edema. Ther Adv Endocrinol Metab. 2013;4(6):151-169. doi:10.1177/2042018813512360 - DOI - PMC - PubMed

MeSH terms

Substances