Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Department of Ophthalmology, Rajavithi Hospital, Rungsit University, Bangkok, Thailand.
Transl Vis Sci Technol. 2023 Oct 3;12(10):2. doi: 10.1167/tvst.12.10.2.
To explore outcomes and biomarkers associated with retinal fluid instability represented by a new parameter in neovascular age-related macular degeneration (nAMD).
Patients with treatment-naïve nAMD receiving anti-vascular endothelial growth factor (VEGF) injections for a duration of 1 to 3 years were consecutively reviewed. Fluctuation Index (FI) of each eye, calculated by averaging the sum of differences in 1-mm central subfield thickness between each follow-up from months 3 to 24, was arranged into ascending order from the lowest to the highest and split equally into low, moderate, and high fluctuation groups. Outcomes were analyzed at 24 months.
Of 558 eyes, FI values showed a negative correlation with a degree-response gradient with 24-month visual improvement. After controlling for baseline best-corrected visual acuity and potential confounders, eyes with low fluctuation gained more Early Treatment Diabetic Retinopathy Study letters than those in the moderate and high fluctuation group (Δ, 10.1 and 14.0 letters, respectively). Significant best-corrected visual acuity improvement from baseline to month 24 (11.8 letters) was observed exclusively in the low fluctuation group despite the indifference in the number of injections and types of anti-VEGF drug used among groups. Patients presenting with central subfield thickness of ≥405 µm or intraretinal fluid coinciding with subretinal fluid showed a significant association with foveal thickness instability during the maintenance phase.
Apart from the central subfield thickness values, unstable macular thickening represented by the FI was associated with some baseline features and may contribute to substandard visual outcomes.
FI may be a valuable tool for assessing therapeutic adequacy in the treatment of nAMD.
探讨新参数代表的新生血管性年龄相关性黄斑变性（nAMD）中视网膜液不稳定的结果和生物标志物。
对接受抗血管内皮生长因子（VEGF）注射治疗、治疗时间为 1 至 3 年的未经治疗的 nAMD 患者进行连续回顾性分析。通过计算每个月 3 至 24 个月之间每个随访的 1 毫米中央小视野厚度之间差异的总和，得出每个眼的波动指数（FI）。FI 值按照从低到高的顺序排列，并分为低、中、高波动组。在 24 个月时分析结果。
在 558 只眼中，FI 值与 24 个月视觉改善的程度反应梯度呈负相关。在控制基线最佳矫正视力和潜在混杂因素后，低波动组的视力比中、高波动组获得了更多的早期治疗糖尿病视网膜病变研究字母（Δ，分别为 10.1 和 14.0 个字母）。尽管在注射次数和抗 VEGF 药物类型方面各组间没有差异，但仅在低波动组中观察到从基线到第 24 个月的最佳矫正视力有显著改善（11.8 个字母）。在维持阶段，中央小视野厚度≥405 µm 或视网膜内液与视网膜下液同时存在的患者，与黄斑厚度不稳定有显著相关性。
除了中央小视野厚度值外，FI 代表的不稳定黄斑增厚与一些基线特征相关，可能导致视觉预后不佳。
FI 可能是评估 nAMD 治疗效果的有用工具。
