Predominantly Persistent Subretinal Fluid in the Comparison of Age-Related Macular Degeneration Treatments Trials

OBJECTIVE: To describe predominantly persistent subretinal fluid (SRF) in eyes receiving ranibizumab or bevacizumab for neovascular age-related macular degeneration and compare visual acuity (VA) to eyes with non-persistent SRF. DESIGN: Cohort within randomized clinical trial PARTICIPANTS: Comparison of Age-related Macular Degeneration Treatments Trials patients assigned to pro re nata (PRN) treatment. METHODS: Reading center graders evaluated optical coherence tomography scans at baseline and monthly follow-up visits for SRF. Predominantly persistent SRF through week 12 was defined as SRF at baseline, weeks 4, 8, and 12. Predominantly persistent SRF through 1 or 2 years was defined as SRF in ≥80% of visits by year 1 or year 2, respectively. Adjusted mean VA score and VA change from baseline were compared between eyes with predominantly persistent SRF and eyes non-persistent SRF over the same duration using linear regression models including baseline predictors of VA and predominantly persistent intraretinal fluid (IRF). PRIMARY OUTCOME MEASURES: Predominantly persistent SRF through year 1, adjusted VA score and VA change, and SRF thickness at the foveal center. RESULTS: Among 406 eyes with baseline SRF, SRF persisted in 108 (26.6%) through week 12, 94 (23.2%) through year 1, and 77 (19.0%) through year 2. Adjusted VA means (letters) at year 1 were similar between eyes with predominantly persistent vs. non-persistent SRF by week 12, (68.1 vs. 70.2; P=0.18), year 1 (67.6 vs. 70.2; P=0.11), and year 2 (71.4 vs. 70.9; P=0.78). Adjusted change in VA at year 1 means were similar between eyes with predominantly persistent vs. non-persistent SRF by week 12 (6.3 vs. 7.6; P=0.38), year 1 (5.5 vs. 7.8; P=0.14), and year 2 (8.1 vs. 7.7; P=0.78). Among eyes with predominantly persistent SRF through year 1, SRF was absent in the foveal center in 46 (48.9%), thickness was 1-200 μm in 48 (50.0%) and >200 μm in 1 (1.1%) at year 1. CONCLUSIONS: Eyes with predominantly persistent and non-persistent SRF through week 12, year 1, or year 2 had similar VA outcomes after adjustment for baseline covariates and persistent IRF. At the foveal center, predominantly persistent SRF was most commonly absent or present in small quantities.