Asadi Khameneh Esmaeil, Asadigandomani Hassan, Khalili Pour Elias, Sadeghi Reza, Mirzaei Arash, Bayan Nikoo, Shojaei Shayan, Mohammadi Nader, Fadaei Fard Shahed, Faghihi Hooshang, Riazi-Esfahani Hamid
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Qazvin Street, Tehran, Iran.
Int Ophthalmol. 2025 Apr 12;45(1):154. doi: 10.1007/s10792-025-03503-8.
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.
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.
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.
Persistent SRF in nAMD does not necessarily lead to worse visual outcomes. Standardized protocols and further research are needed to improve management strategies.
新生血管性年龄相关性黄斑变性（nAMD）中持续性视网膜下液（SRF）的管理方法各异，且缺乏对不同治疗方法疗效的全面综述。本系统评价旨在评估治疗nAMD患者持续性SRF的干预措施的疗效。
采用结构化检索策略，对治疗伴有持续性SRF的nAMD的抗血管内皮生长因子（VEGF）治疗进行系统评价。去除重复文献后，筛选出861篇文章，255篇进行全文审查，19篇符合纳入标准。
纳入研究显示，nAMD患者持续性SRF的管理效果各异。多项研究支持对SRF采取耐受策略，表明有持续性SRF和无持续性SRF的患者之间视力无显著差异。相反，一些研究主张采取更积极的治疗方法，结果显示SRF显著减少且可能带来视力改善。与伴有视网膜内液或囊肿的患者相比，伴有SRF的患者通常视力预后更好。高频抗VEGF治疗方案，尤其是阿柏西普治疗方案，可减少SRF并维持视力。然而，采用不太积极的治疗方案可通过较少的注射次数获得稳定疗效。
nAMD中的持续性SRF不一定会导致更差的视力预后。需要标准化治疗方案和进一步研究以改进管理策略。
