Paradoxical resolution of refractory subretinal fluid in dome-shaped macula after discontinuation of anti-VEGF therapy

Chronic subretinal fluid (SRF) is a common complication of dome-shaped macula (DSM), yet its optimal management remains uncertain. This paper presents a case of spontaneous resolution of chronic SRF associated with DSM following discontinuation of anti-vascular endothelial growth factor (anti-VEGF) therapy. The patient, in her late 70s, with DSM and chronic SRF in the left eye was treated with multiple anti-VEGF agents, including ranibizumab, aflibercept and faricimab, over 19 months. Despite ongoing therapy, her SRF persisted and best-corrected visual acuity (BCVA) remained stable at 20/20 to 20/25. 45 days after treatment cessation, optical coherence tomography showed complete resolution of SRF. Over 26 months of subsequent observation without further treatment, the retina remained dry and BCVA remained stable. This suggests that in DSM, chronic SRF refractory to anti-VEGF therapy may spontaneously resolve after discontinuing treatment. Observation is a reasonable management strategy in specific patients to minimise unnecessary injections and associated risks.