Baseline characteristics of eyes with early residual fluid post loading phase of aflibercept therapy in neovascular AMD: PRECISE study report 3

PurposeTo compare the baseline characteristics in patients with and without early residual fluid (ERF) after aflibercept loading phase (LP) in patients with treatment naive neovascular age related macular degeneration (nAMD).MethodsPatients with nAMD initiated on LP of three intravitreal aflibercept doses were recruited from December 2019 to August 2021. Baseline demographic and OCT features associated with any ERF were analysed using Generalised Estimating Equations to account for inter-eye correlation. Receiver operating characteristic (ROC) curve was performed for selection of CST threshold.ResultsOf 2128 patients enrolled, 1999 eyes of 1862 patients with complete data were included. After LP, ERF was present in 1000 (50.0%), eSRF in 746(37.3%) and eIRF in 428 (21.4%) eyes. In multivariable analysis of baseline features, eyes with increased central subfield thickness (CST) (OR 1.31 per 100 microns increase [95% CI 1.22 to 1.41]; P < 0.001), eyes with IRF and SRF at baseline (1.62 [95% CI 1.17 to 2.22]; P = 0.003), and those with SRF only (OR 2.26 [95% CI 1.59 to 3.20]; P < 0.001) relative to IRF only were determinants of ERF. CST >= 418 microns had 57% sensitivity and 58% specificity to distinguish ERF from no ERF at visit 4.ConclusionOn average, 50% of eyes have ERF after aflibercept LP. Clinically relevant baseline determinants of ERF include CST >= 418 mu and presence of only SRF. These eyes may require further monthly treatment before extending treatment intervals.

Automated summary

The study aimed to compare the baseline characteristics in patients with and without early residual fluid (ERF) after aflibercept loading phase (LP) in patients with treatment naive neovascular age related macular degeneration (nAMD). The study found that increased central subfield thickness (CST) and the presence of intraretinal fluid (IRF) and subretinal fluid (SRF) at baseline were the main determinants of ERF.