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Non-neovascular age-related macular degeneration with subretinal fluid
  1. Assaf Hilely1,
  2. Adrian Au2,
  3. K Bailey Freund3,
  4. Anat Loewenstein1,
  5. Eric H Souied4,
  6. Dinah Zur1,
  7. Riccardo Sacconi5,
  8. Enrico Borrelli5,
  9. Enrico Peiretti6,
  10. Claudio Iovino6,
  11. Yoshimi Sugiura7,
  12. Abdallah A Ellabban8,9,
  13. Jordi Monés10,
  14. Nadia K. Waheed11,
  15. Sengul Ozdek12,
  16. Duygu Yalinbas12,
  17. Sarah Thiele13,
  18. Luísa Salles de Moura Mendonça11,
  19. Mee Yon Lee14,
  20. Won Ki Lee15,
  21. Pierre Turcotte16,
  22. Vittorio Capuano4,
  23. Meryem Filali Ansary4,
  24. Usha Chakravarthy17,
  25. Albrecht Lommatzsch18,
  26. Frederic Gunnemann18,
  27. Daniel Pauleikhoff18,
  28. Michael S Ip19,
  29. Giuseppe Querques5,
  30. Frank G Holz13,
  31. Richard F Spaide3,
  32. SriniVas Sadda19,
  33. David Sarraf2,20
  1. 1 Division of Ophthalmology, Tel Aviv Ichilov-Sourasky Medical Center, Tel Aviv, Israel
  2. 2 Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
  3. 3 Vitreous Retina Macula Consultants of New York, New York, New York, USA
  4. 4 Ophthalmology, Centre Hospitalier Intercommunal De Creteil, Creteil, France
  5. 5 Ophthalmology, Ospedale San Raffaele, Milano, Italy
  6. 6 Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
  7. 7 Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Japan
  8. 8 Hull University Teaching Hospitals NHS Trust, Hull, UK
  9. 9 Suez Canal University Faculty of Medicine, Ismailia, Egypt
  10. 10 Barcelona Macula Foundation, Barcelona, Spain
  11. 11 New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts, USA
  12. 12 Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
  13. 13 Ophthalmology, University of Bonn, Bonn, Germany
  14. 14 Catholic University of Korea College of Medicine, Seoul, South Korea
  15. 15 Nune Eye Hospital, Seoul, South Korea
  16. 16 Private practice, Quebec City, Canada
  17. 17 Department of Ophthalmology, Queen’s University of Belfast, Belfast, UK
  18. 18 Department of Ophthalmology, Sankt Franziskus-Hospital Münster GmbH, Munster, Germany
  19. 19 Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
  20. 20 Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California, USA
  1. Correspondence to David Sarraf, Stein Eye Institute, University of California, 100 Stein Plaza, Los Angeles, CA 90095, USA; dsarraf{at}


Purpose To evaluate the various patterns of subretinal fluid (SRF) in eyes with age-related macular degeneration (AMD) in the absence of macular neovascularisation (MNV) and to assess the long-term outcomes in these eyes.

Methods This retrospective study included only eyes with non-neovascular AMD and associated SRF. Eyes with evidence of MNV were excluded. Spectral-domain optical coherence tomography (SD-OCT) was obtained at baseline and at follow-up, and qualitative and quantitative SD-OCT analysis of macular drusen including drusenoid pigment epithelial detachment (PED) and associated SRF was performed to determine anatomic outcomes.

Results Forty-five eyes (45 patients) were included in this analysis. Mean duration of follow-up was 49.7±36.7 months. SRF exhibited three different morphologies: crest of fluid over the apex of the drusenoid PED, pocket of fluid at the angle of a large druse or in the crypt of confluent drusen or drape of low-lying fluid over confluent drusen. Twenty-seven (60%) of the 45 eyes with fluid displayed collapse of the associated druse or drusenoid PED and 24 (53%) of the 45 eyes developed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy.

Conclusion Non-neovascular AMD with SRF is an important clinical entity to recognise to avoid unnecessary anti-vascular endothelial growth factor therapy. Clinicians should be aware that SRF can be associated with drusen or drusenoid PED in the absence of MNV and may be the result of retinal pigment epithelial (RPE) decompensation and RPE pump failure.

  • Retina
  • Angiogenesis
  • Choroid
  • Degeneration
  • Macula

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  • The paper was presented at the 7th International Congress, Rome, Italy, December 2019.

  • Contributors No contributorship was associated with the study.

  • Funding This study was supported by the Research to Prevent Blindness (DS), New York, New York, USA and the Macula Foundation (DS, KBF), New York, New York, USA.

  • Competing interests None declared.

  • Ethics approval Institutional review board (IRB) approval was obtained from the UCLA IRB Office of Human Protection, IRB#11-000324.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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