Treating or tolerating persistent subretinal fluid in neovascular age-related macular degeneration: a systematic review of visual and anatomical outcomes with anti-VEGF therapy

Abstract

Purpose: The management of persistent subretinal fluid (SRF) in neovascular age-related macular degeneration (nAMD) varies, with no comprehensive review of outcomes from different treatment approaches. This systematic review evaluates the efficacy of interventions for managing persistent SRF in nAMD patients.

Methods: Using a structured search strategy, a systematic review examined anti-vascular endothelial growth factor (VEGF) treatments for nAMD with persistent SRF. After removing duplicates, 861 articles were screened, 255 underwent full-text review, and 19 met the eligibility criteria.

Results: The included studies demonstrated variable outcomes regarding the management of persistent SRF in nAMD. Several studies supported tolerating SRF, showing no significant difference in visual acuity between patients with and without persistent SRF. Conversely, some studies advocated for more aggressive treatment, demonstrating a significant reduction in SRF and potential visual benefits. Patients with SRF generally have better visual outcomes compared to those with intraretinal fluid or cysts. High-frequency anti-VEGF regimens, especially with aflibercept, reduce SRF and maintain visual acuity. However, less aggressive protocols achieve stable outcomes with fewer injections.

Conclusion: Persistent SRF in nAMD does not necessarily lead to worse visual outcomes. Standardized protocols and further research are needed to improve management strategies.

Keywords: Anti-VEGF therapy; Individualized treatment; Neovascular age-related macular degeneration; Persistent subretinal fluid; Systematic review; Visual outcomes.