The localization of intraretinal cysts has a clinical role on the two-year outcome of neovascular age-related macular degeneration

Objective: To assess the relationship between one or more localizations of intraretinal fluid (IRF) within retinal layers and the 2-year outcome in a cohort of neovascular age-related macular degeneration (AMD) eyes. Design: retrospective case series. Participants: 243 eyes of 243 AMD patients affected by type 1 and type 2 macular neovascularization (MNV). Methods: We analyzed data considering MNV onset, 1-year and 2-year timepoints. Optical coherence tomography (OCT) images were used to classify MNV types, to distinguish different types of fluids and to assess IRF localization within retinal layers. A sub-cohort of eyes were also analyzed by OCT angiography. Main outcome measures: The association between IRF cysts localization and both visual outcome and onset of outer retinal atrophy at 2-year follow-up. Results: MNV were distributed as type 1 (69%) and type 2 (31%). The mean number of intravitreal injections was 7±2 at 1-year and 5±2 at 2-year follow-up. Baseline BCVA was 0.4±0.3 LogMAR, improving to 0.3±0.4 at 2-year follow-up (p<0.01). Outer retinal atrophy occurred in 24% of cases at 1-year and in 39% of cases at 2-year follow-up. IRF localizations at the level of IPL-INL and OPL-ONL at baseline were associated with the worst functional and anatomical outcome. Moreover, the presence of IRF at baseline was associated with greater impairment of the intraretinal vascular network. Conclusions: The localization of IRF at the level of IPL-INL and OPL-ONL retinal layers represents a negative prognostic biomarker for the morphologic and function outcomes of neovascular AMD.