Predominantly Persistent Intraretinal Fluid Linked With Worse Visual Acuity, Scars at 2 Years

Retinal Scar
Wide angle fundus photograph showing a retinal scar in the periphery.
Researchers conducted a post hoc analysis of eyes undergoing pro re nata ranibizumab or bevacizumab treatment in the Comparison of Age-Related Macular Degeneration Treatment Trials.

Predominantly persistent intraretinal fluid (PP-IRF) throughout a 2-year duration is associated with worse long-term visual acuity (VA) and scar development, according to research published in Ophthalmology Retina.

Investigators conducted a secondary analysis of the Comparison of Age-Related Macular Degeneration Treatment Trials ([CATT], identifier NCT00593450) in which they assessed participants receiving pro re nata (PRN) ranibizumab or bevacizumab injections for neovascular age-related macular degeneration. The team  evaluated the impact of PP-IRF on visual acuity (VA) in this post-hoc analysis. They included 363 eyes with baseline intraretinal fluid (IRF) and performed monthly optical coherence tomography (OCT) imaging for a period of 2 years. Two graders assessed images for fluid presence and location. The team assessed PP-IRF over periods of 12 weeks, 1 year, and 2 years.

The researchers noted that 32% (n=16) of eyes with IRF at baseline had PP-IRF through week 12. Among those eyes, approximately 70% had PP-IRF through year 1, and 60% had it through year 2.

The investigators determined that PP-IRF at 2 years was associated with lower adjusted 1-year mean VA (letters) score (64.8 vs 69.2; P =.006) and change (4.3 vs 8.1; P =.01) as well as 2-year mean VA score (63.0 vs. 68.3; P =.004) and change (2.4 vs. 7.1; P =.009). PP-IRF through 2 years was linked with an increased risk of scar development at 2 years (HR, 1.49; P =.03).

“It is important to recognize the tendency of IRF to recur after resolution has been achieved with anti-VEGF therapy, especially in eyes that exhibit a slower initial resolution,” according to the researchers. “Accordingly, for those patients who are treated on a PRN or treat and extend regimen, if IRF resolution does not occur until after 12 weeks, it may be reasonable for the clinician to consider an earlier follow-up visit, after initial fluid resolution, to prevent an extended period of untreated IRF following fluid recurrence.”

Limitations of the study include a small sample of eyes with foveal PP-IRF and the use of time-domain OCT instead of spectral domain OCT.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Core JQ, Pistilli M, Hua P, et al. Predominantly persistent intraretinal fluid in the comparison of age-related macular degeneration treatments trials (CATT). Ophthalmol Retina. Published online April 9, 2022. doi:10.1016/j.oret.2022.03.024