Role of retinal fluid location in atrophy and fibrosis evolu
A study was conducted to assess the effect of clinical factors on the development and progression of atrophy and fibrosis in patients with neovascular age-related macular degeneration (nAMD) receiving long-term treatment in the real world.

An ambispective 36-month multicentre study, involving 359 nAMD patients treated according to the Spanish Vitreoretinal Society guidelines, was designed. The influence of demographic and clinical factors, including the presence and location of retinal fluid, on best-corrected visual acuity (BCVA) and progression to atrophy and/or fibrosis were analysed.

--After 36 months of follow-up and an average of 13.8 anti-VEGF intravitreal injections, the average BCVA gain was +1.5 letters, and atrophy and/or fibrosis were present in 54.8% of nAMD patients.

--Atrophy was associated with basal intraretinal fluid (IRF), whereas basal subretinal fluid (SRF) was associated with a lower rate of atrophy and its progression, leading to a slow progression rate.

--Fibrosis development and progression were related to IRF at any visit.

--In contrast, 36-month SRF was related to a lower rate of fibrosis (OR = 0.49) and its progression (OR = 0.50).

Conclusively, 1 out of 2 nAMD patients treated for three years had atrophy and/or fibrosis. Both lead to eyesight loss, in particular fibrosis. In subretinal fluid (SRF), good visual outcomes were associated with low atrophy and fibrosis rates, however in ordinary clinical practice, IRF leads in worse optical outcome, a higher risk of atrophy and in particular fibrosis.