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BRIDGE ARCH–SHAPED SUBRETINAL FLUID IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

This study talks about bridge arch–shaped subretinal fluid, a rare optical coherence tomography finding seen in neovascular age-related macular degeneration. The study discusses about its pathogenesis and its effects on the final anatomical and visual outcomes. Purpose: To study factors leading to bridge arch–shaped subretinal fluid (SRF) on optical coherence tomography in wet age-related macular degeneration and evaluate its anatomical and functional outcomes. Methods: In this single-center, retrospective study, patients with bridge arch–shaped SRF and choroidal neovascular membrane (CNVM) were included. Results: Overall, 623 eyes in 431 patients with chronic CNVM were identified, and 24 eyes (4%) in 21 patients showed bridge arch–shaped SRF. Mean age of patients was 69.19 ± 12.0 years. Type-1 CNVM was noted in 79% cases before development of bridge arch-shaped SRF. Mean early treatment diabetic retinopathy letters visual acuity was 53.93 ± 32.19. Time interval to develop bridge arch–shaped SRF was 21.9 ± 30.63 months. Mean number of intravitreal anti–vascular endothelial growth factor injections given before developing bridge arch–shaped SRF was 6.5 ± 7.09. During the development of bridge arch–shaped SRF, visual acuity reduced by −20.57 ± 31.13 letters (P = 0.033) and fibrotic Type-2 CNVM (n = 18, 75%) was noted. Retinal pigment epithelium tear was noted in 8 eyes (33%). At the final visit, further reduction in visual acuity of −7.136 ± 13.73 early treatment diabetic retinopathy letters (P = 0.011) after developing bridge arch–shaped SRF was seen. Mean number of injections given after developing bridge arch–shaped SRF was 4.76 ± 3.76. Conclusion: Bridge arch–shaped SRF is an uncommon finding seen in eyes with Type-2 chronic CNVMs. Presence of retinal pigment epithelium breach and tear and nonaggressive treatment regimen with intravitreal anti–vascular endothelial growth factor injections could be responsible for its pathogenesis. It is a marker of fibrotic enlargement, leading to poor visual outcomes despite showing favorable therapeutic response.