Prevalence of Prechoroidal Cleft Reported in Caucasian nAMD Patients

Dinah Zur, MD

Eyes with neovascular age-related macular degeneration (nAMD) saw a significant correlation between the development of prechoroidal cleft and higher baseline central subfield foveal thickness (CSFT) and the presence of multi-layered pigment epithelial detachment (PED).

Prechoroidal cleft was found in 15% of Caucasian nAMD patients treated with anti-VEGF injection in the findings, while eyes with prechoroidal cleft additionally required more anti-VEGF injections.

Investigators suggest the presence of prechoroidal cleft correlated with disease activity and intensive suppression of anti-VEGF injection may preserve vision in this population.

“According to our findings, with adequate VEGF suppression eyes with PC can achieve visual outcomes which are comparable with eyes without cleft,” wrote study author Dinah Zur, MD, Division of Ophthalmology, Tel Aviv Sourasky Medical Center.

The determination of a hyporeflective space between the neovascular hyperreflective tissue and Bruch’s membrane was in nAMD patients on OCT was named as “prechoroidal cleft.” A recent study reported a correlation between size of the cleft and nAMD exudative activity, but the prevalence of prechoroidal cleft in a Caucasuain nAMD population remains unknown.

Zur and colleagues reviewed patient records at the Tel Aviv Medical Center from January 2014 to December 2017 to determine consecutive cases of nAMD treated with anti-VEGF injections. A total of 140 patients with naive nAMD treated with anti-VEGF injections with a follow-up  of ≥24 months were included in the study.

OCT scans were assessence for the presence of morphological features including, subretinal fluid (SRF), intraretinal fluid (IRF), PED, CSFT, maximal retinal thickness (MRT), and subretinal hyperreflective material (SHRM). All features were graded at baseline and months 3, 6, 12, and 24. Investigators additionally recorded best-corrected visual acuity (BCVA) and anti-VEGF treatments.

Of the study population, 21 eyes (15%) developed a prechoroidal cleft during follow-up, on average 9.5 months from macular neovascularization (MNV) diagnosis.

The mean baseline BCVA for the whole cohort was 0.68 ±  0.56 logMAR and the mean baseline CSFT  and MRT were 468  ± 205 μm and 583 ± 258 μm, respectively. The mean number of anti-VEGF injections during follow-up was 19.0 ± 6.4 over mean follow-up duration of  31.6 months.

Data show the number of injections was significantly higher in patients with cleft (23.4 ±  4.3)  compared to patients without cleft (18.2 ±  6.5, P =  .001).

Multivariate analysis confirmed that higher CSFT (P = .011; odds ratio [OR], 1.004; 95% confidence interval [CI], 1.001 - 1.007) and multilayered PED (P <.001; OR, 21.153; 95% CI, 5.591 - 80.026) were predictive biomarkers for the development of cleft.

Additionally, BCVA improved significantly over time to 0.62 ±  0.59 logMAR after 24 months (P = .008), but the change was not related to the presence of cleft (P = .208).

“Our results reveal a significant correlation between development of cleft and the following OCT  biomarkers: higher CSFT, MRT, PED height and the presence of multi-layered PED,” Zur wrote.

The study, “Risk factors and clinical significance of prechoroidal cleft in eyes with neovascular age-related macular degeneration in Caucasian patients,” was published in Acta Ophthalmologica.