Fluid as a critical biomarker in neovascular age-related macular degeneration management: literature review and consensus recommendations

Eye (Lond). 2021 Aug;35(8):2119-2135. doi: 10.1038/s41433-021-01487-0. Epub 2021 Apr 1.

Abstract

Current guidelines on the management of patients with neovascular age-related macular degeneration (nAMD) lack clear recommendations on the interpretation of fluid as seen on optical coherence tomography (OCT) imaging and the incorporation of this information into an ongoing disease treatment strategy. Our objective was to review current guidelines and scientific evidence on the role of fluid as a biomarker in the management of nAMD, and develop a clinically oriented, practical algorithm for diagnosis and management based on a consensus of expert European retinal specialists. PubMed was searched for articles published since 2006 relating to the role of fluid in nAMD. A total of 654 publications were screened for relevance and 66 publications were included for review. Of these, 14 were treatment guidelines, consensus statements and systematic reviews or meta-analyses, in which OCT was consistently recommended as an important tool in the initial diagnosis and ongoing management of nAMD. However, few guidelines distinguished between types of fluid when providing recommendations. A total of 52 publications reported primary evidence from clinical trials, studies, and chart reviews. Observations from these were sometimes inconsistent, but trends were observed with regard to features reported as being predictive of visual outcomes. Based on these findings, diagnostic recommendations and a treatment algorithm based on a treat-and-extend (T&E) regimen were developed. These provide guidance on the diagnosis of nAMD as well as a simple treatment pathway based on the T&E regimen, with treatment decisions made according to the observations of fluid as a critical biomarker for disease activity.

摘要: 积液作为新生血管性年龄相关黄斑变性治疗的关键性生物标志物: 文献回顾及共识建议摘要目前关于新生血管性年龄相关性黄斑变性 (nAMD) 患者的管理指南中缺乏相干光断层扫描 (OCT) 中积液的阐释, 也没有明确的建议将该信息纳入正在制定的疾病治疗策略中。本文旨在总结目前积液作为生物标志物在nAMD中治疗作用的相关指南及科学证据, 并基于欧洲视网膜专家共识, 开发以临床需求为导向的具有实用价值的诊断和管理的算法。我们检索了PubMed数据库并查找自2006年以来发表的关于积液在nAMD中作用的文献。共筛选654篇文章, 纳入66篇文章以综述回顾。其中, 14项为治疗指南、共识陈述、系统综述及meta分析, 其中OCT被一致推荐作为nAMD的初始诊断和后续管理的重要工具。然而, 在提供建议时, 很少有指南会区分不同类型的液体。共有52篇文献报道了来自临床试验、研究和图表评论的主要证据。这些观察结果有时是不一致的, 但在预测视力方面有一定特征性的趋势。基于这些发现, 我们提出了诊断建议和基于T&E方案的治疗算法。这为nAMD的诊断提供了指导, 同时也为T&E方案提供了一个简单的治疗途径, 即根据观察到的积液作为疾病活动的关键生物标志物来决定治疗方案。.

Publication types

  • Review

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use
  • Biomarkers
  • Consensus
  • Humans
  • Macular Degeneration* / drug therapy
  • Tomography, Optical Coherence
  • Wet Macular Degeneration* / diagnosis
  • Wet Macular Degeneration* / drug therapy

Substances

  • Angiogenesis Inhibitors
  • Biomarkers