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Regenerative Therapy by Suprachoroidal Cell Autograft in Dry Age-related Macular Degeneration: Preliminary In Vivo Report
Published on: February 12, 2018
Anti-VEGF-resistant subretinal fluid is associated with better vision and reduced risk of macular atrophy
Marco A Zarbin1, Lauren Hill2, Andreas Maunz3
1Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA zarbin@rutgers.edu.
Background/Aim:
To evaluate relationships between subretinal fluid (SRF), macular atrophy (MA) and visual outcomes in ranibizumab-treated neovascular age-related macular degeneration (nAMD).
Methods:
This post hoc HARBOR trial (NCT00891735) analysis included ranibizumab-treated (0.5 or 2.0 mg, monthly or as-needed, all treatment arms pooled) eyes with nAMD and baseline (screening, baseline and week 1) SRF. SRF presence, SRF thickness (0, >0-50, >50-100 and >100 µm) and subretinal fluid volume (SRFV) were determined by spectral domain optical coherence tomography (SD-OCT). Best-corrected visual acuity (BCVA) was assessed. MA was identified using fluorescein angiograms and colour fundus photographs, as well as SD-OCT.
Results:
Seven hundred eighty-five of 1097 eyes met analysis criteria. In eyes without baseline MA, residual versus no SRF at month (M) 3 was associated with lower MA rates at M12 (5.1% vs 22.1%) and M24 (13.3% vs 31.2%) (both p<0.0001); MA percentages at M12/M24 were similar among patients with residual SRF at M6. Higher baseline SRFV was associated with a lower MA rate. Greater mean BCVA was observed with residual SRF of any thickness (>0-50 µm, 71.2 letters; >50-100 µm, 71.3 letters; >100 µm, 69.2 letters) versus no SRF (63.6 letters), but the change in BCVA from baseline to M12 or M24 was the same for eyes with or without treatment-resistant subretinal fluid (TR-SRF) at M3 or M6.
Conclusion:
TR-SRF was not detrimental to vision outcomes over 2 years, regardless of thickness. MA rates were significantly higher without TR-SRF.
Insights
Subretinal fluid (SRF) in ranibizumab-treated neovascular age-related macular degeneration (nAMD) did not harm vision outcomes. However, higher rates of macular atrophy (MA) were observed in patients without persistent SRF.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Age-Related Macular Degeneration
Background:
- Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss.
- Subretinal fluid (SRF) and macular atrophy (MA) are key indicators of disease progression and visual impairment in nAMD.
- Understanding the interplay between SRF, MA, and visual outcomes is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the relationship between subretinal fluid (SRF), macular atrophy (MA), and visual outcomes in patients with nAMD treated with ranibizumab.
- To determine if persistent SRF impacts the development of MA and best-corrected visual acuity (BCVA) over two years.
- To analyze the association between baseline SRF characteristics and subsequent MA development and visual function.
Main Methods:
- A post hoc analysis of the HARBOR trial (NCT00891735) involving ranibizumab-treated nAMD eyes.
- Spectral domain optical coherence tomography (SD-OCT) was used to assess SRF presence, thickness, and volume.
- Macular atrophy (MA) was identified using multimodal imaging, and best-corrected visual acuity (BCVA) was measured.
Main Results:
- In eyes without baseline MA, residual SRF at Month 3 was associated with significantly lower MA rates at Months 12 and 24 compared to no SRF.
- Higher baseline subretinal fluid volume (SRFV) correlated with a lower MA rate.
- Eyes with residual SRF of any thickness showed greater mean BCVA compared to eyes without SRF, although the change in BCVA over time was similar for eyes with or without treatment-resistant SRF (TR-SRF).
Conclusions:
- Treatment-resistant subretinal fluid (TR-SRF) was not detrimental to visual outcomes over two years in ranibizumab-treated nAMD patients.
- Significantly higher rates of macular atrophy (MA) were observed in eyes without TR-SRF.
- The presence of residual SRF, even if persistent, may be associated with a lower risk of MA development.
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