Risk factors and clinical significance of prechoroidal cleft in eyes with neovascular age‐related macular degeneration in Caucasian patients

• Published in: Acta ophthalmologica (Oxford, England) Vol. 101; no. 3; pp. e338 - e345
• Main Authors: Kredi, Gili, Iglicki, Matias, Gomel, Nir, Hilely, Assaf, Loewenstein, Anat, Habot‐Wilner, Zohar, Zur, Dinah
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-05-2023
• Subjects: Acuity; age‐related macular degeneration; Angiogenesis Inhibitors - therapeutic use; choroidal cleft; choroidal neovascularization; Clinical Relevance; Clinical significance; Eye; Humans; Intravitreal Injections; Macular degeneration; Macular Degeneration - drug therapy; Multivariate analysis; optical coherence tomography; Retina; Retinal Detachment - drug therapy; Retinal Pigment Epithelium; Retrospective Studies; Risk Factors; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A; White people; choroidal cleft; choroidal neovascularization; optical coherence tomography; age-related macular degeneration
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/aos.15273

Objective
The objective of the study was to investigate the prevalence, risk factors and clinical significance of prechoroidal cleft (PC) among neovascular age‐related macular degeneration (nAMD) patients in a Caucasian population.
Design
A retrospective observational cohort study.
Methods
A total of 140 patients with naive nAMD were treated with anti‐vascular endothelial growth factor (VEGF) injections and a follow‐up of ≥24 months. Optical coherence tomography (OCT) scans were graded for the presence of PC, central subfield foveal thickness (CSFT), maximal retinal thickness (MRT), pigment epithelial detachment (PED), presence of intraretinal fluid (IRF), subretinal fluid (SRF) and subretinal hyper‐reflective material (SHRM) at baseline, 3, 6, 12 and 24 months. Best corrected visual acuity (BCVA) and anti‐VEGF treatments were recorded.
Results
Out of 140, 21 eyes (15%) developed PC. BCVA improved significantly from 0.68 ± 0.56 to 0.62 ± 0.59 logMAR after 24 months (p = 0.008). The change in BCVA was not related to the presence of cleft (p = 0.208). Multivariate analysis confirmed that higher baseline CSFT (p = 0.011, OR = 1.004, 95%, CI 1.001–1.007) and the presence of multi‐layered PED (p < 0.001, OR = 21.153, 95%, CI 5.591–80.026) were both predictive for development of PC. Eyes with PC received more injections than eyes without PC.
Conclusion
Prechoroidal cleft was found in 15% of Caucasian nAMD patients treated with anti‐VEGF injections and was related to greater retinal and PED height, as well as presence of multi‐layered PED. Eyes with PC required more anti‐VEGF injections. The presence of PC correlates with disease activity, and intensive anti‐VEGF suppression can preserve vision.