Complications Associated with Worse Visual Outcomes in Patients with Exudative Neovascular Age-Related Macular Degeneration

Abstract

<b><i>Background:</i></b> Neovascular age-related macular degeneration (AMD) represents a leading cause of vision loss in older subjects. The introduction of anti-vascular endothelial growth factor therapy has enormously improved the visual prognosis in these patients. <b><i>Summary:</i></b> However, severe complications may still occur in this disease and their development may significantly affect short- and long-term visual outcomes. <b><i>Key Messages:</i></b> In this article, we provided a review of these complications, highlighting their distinctive signs or symptoms and focusing on the current evidence of treatment. To place the complications related to neovascular AMD in a proper context, this review deals with core components essential for proper comprehension of neovascular AMD that includes pathogenesis, clinical signs, and basic principles of treatment.

Macular Neovascularization Secondary to Subclinical Angioid Streaks in Age-Related Macular Degeneration: Treatment Response to Anti-VEGF at 2-Year Follow-up

“…The development of CNV is a frequent scenario in patients affected by AS, facilitated by the locus minoris resistentiae of the BM interruption. However, CNVs secondary to AS are usually characterized by a worse prognosis due to the predominance of type 2 CNV, a high number of injections needed, and development of fibrosis and/or atrophy with worse visual outcomes [ 9 – 13 ]. Different molecules showed efficacy in stabilization of BCVA up to 4-year follow-up in CNV secondary to AS [ 11 , 12 , 14 – 18 ].…”

“…The main therapy of MNV/CNV is based on intravitreal antivascular endothelial growth factor (VEGF) injections. Nevertheless, the treatment response of neovessels (i.e., number of injections needed, treatment regimen, development of fibrosis and/or atrophy) is different based on the background disease [ 11 – 13 ]. The pathogenesis of subclinical AS phenotype showed several differences compared to other AMD phenotypes because of the greater involvement of the BM.…”

Distinct Pathways of Macular Atrophy in Type 3 Macular Neovascularization Associated With AMD

“…The criteria for excluding individuals from the study were as follows: (i) the presence of concomitant Type 1 or 2 MNV, (ii) the existence of fibrosis at baseline, determined through fundus examination and structural OCT assessment, 10 (iii) indications of RPE tear, 11 (iv) prior history of vitreoretinal surgery in the eye under study, and (v) the presence of other disorders affecting the macula or optic nerve. All patients underwent a complete ophthalmological assessment including structural OCT.…”

Inter-session repeatability of reading performance measures in patients with neovascular AMD

“…1,2 The development and exudation of a macular neovascularization in the AMD setting may result in a damage to inner retina, photoreceptors, and retinal pigment epithelium that may eventually effect in an irreversible impairment of the central vision. 3–7…”

“…1,2 The development and exudation of a macular neovascularization in the AMD setting may result in a damage to inner retina, photoreceptors, and retinal pigment epithelium that may eventually effect in an irreversible impairment of the central vision. [3][4][5][6][7] The introduction of anti-vascular endothelial growth factor therapy has dramatically improved the care of patients with neovascular exudative AMD, and this treatment is currently considered as the gold standard. The management of nAMD patients may include a reg-ular follow-up with a periodic administration of intravitreal anti-vascular endothelial growth factor injections.…”