This review evaluates non-exudative retinal fluid (intraretinal and subretinal) in AMD, examining its imaging features, underlying pathophysiology, and clinical management implications across intermediate AMD and geographic atrophy (GA).
Non-exudative intraretinal fluid arises from three distinct mechanisms — degenerative atrophy, burnt-out fibrotic scarring with cavitation, and mechanical stress from drusenoid PEDs or vitreomacular traction — while non-exudative subretinal fluid reflects RPE pump failure or photoreceptor outer segment alterations; crucially, neither type responds to anti-VEGF therapy.
This is a narrative review without a systematic search or meta-analysis, so conclusions are based on expert synthesis rather than pooled quantitative data. No sample size or comparative outcomes data are reported.
Not all fluid seen on OCT in AMD is neovascular — recognizing non-exudative fluid patterns can prevent unnecessary anti-VEGF treatment. Instead, such fluid signals advanced tissue stress and should prompt monitoring for GA progression rather than escalation of exudation-targeted therapy.
