Differences in Long-Term Progression of Atrophy between Neovascular and Nonneovascular Age-Related Macular Degeneration

Airaldi, Matteo; Corvi, Federico; Cozzi, Mariano; Nittala, Muneeswar Gupta; Staurenghi, Giovanni; Verma, Aditya

doi:10.1016/j.oret.2022.04.012

Cited by 8 publications

(9 citation statements)

References 35 publications

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“…Other factors such as the interval and number of treatments with anti-VEGF agents, age, and degree of myopia were described as risk factors for the development of chorioretinal atrophy. 7 , 9 , 31–33 In our cohort, they did not demonstrate an association with chorioretinal atrophy progression.…”

Section: Discussioncontrasting

confidence: 68%

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Chorioretinal Atrophic Lesions Evolution in Patients with Quiescent Myopic Choroidal Neovascularization Followed for More Than 10 Years

Ferreira,

Vilares-Morgado,

Lima-Fontes

et al. 2024

OPTH

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Purpose To evaluate the progression of chorioretinal atrophic areas associated with myopic choroidal neovascularization (CNV) in high myopic patients followed by a minimum period of 10 years. Patients and Methods Patients with myopic CNV lesions that achieved clinical and structural remissions over 10 years of follow-up were included. Medical records were reviewed for CNV characterization and treatment, best-corrected visual acuity at baseline (BCVA0), immediately after the last treatment (BCVA1) and at the latest visit (BCVA2). Fundus autofluorescence (FAF) was used to quantify the amount of atrophic area increase per year associated with the treated myopic CNV lesion. The first FAF performed after treatment suspension (FAF1) was compared with the most recent exam (FAF2). Results Thirty-six eyes from 36 patients were included. Mean total follow-up was 12.38 ± 2.68 years. Mean number of intravitreal injections (IVI) was 12.50 ± 12.40 and 25% of the eyes had previous treatment with photodynamic therapy (PDT). Mean improvement between BCVA0 and BCVA1 was 5.58 ± 15.98 letters (p < 0.001). However, a drop of 8.03 ± 12.25 letters was noticed between BCVA1 and BCVA2. FAF1 was 6.34 ± 4.92mm 2 and increased to 9.88 ± 7.56mm 2 (3.54 ± 3.79mm 2 variation p < 0.001). The mean growth rate of the atrophic area was 0.89 ± 0.84mm 2 per year. BCVA2 negatively correlated with FAF2 (k = −0.498, p = 0.002) being worse in patients with higher atrophic area growth rate (k = −0.341, p = 0.042). Eyes treated with PDT needed less IVI (5.89 ± 5.21 vs 14.70 ± 13.36, p = 0.008) but had larger FAF1 (9.80 ± 5.33 vs 5.19 ± 4.27, p = 0.013) and FAF2 (16.05 ± 7.10 vs 7.83 ± 6.63, p = 0.003). Hypothyroidism was associated with higher atrophy growth rate (1.55 ± 1.15 vs 0.73 ± 0.67, p = 0.016). Conclusion This research demonstrates the importance of chorioretinal atrophy progression after myopic CNV lesions regression and its impact on visual prognosis, reporting a mean yearly growth of 0.89 mm 2 in atrophic areas. Previous treatment with PDT and hypothyroidism were identified as risk factors associated with larger atrophic areas and worse visual outcomes.

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Section: Discussioncontrasting

confidence: 68%

“…Interestingly, the development of a myopic CNV itself may be associated with slower rate of expansion of the atrophic areas, although the reports are contradictory. 31 , 34 …”

Section: Discussionmentioning

confidence: 99%

Chorioretinal Atrophic Lesions Evolution in Patients with Quiescent Myopic Choroidal Neovascularization Followed for More Than 10 Years

Ferreira,

Vilares-Morgado,

Lima-Fontes

et al. 2024

OPTH

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“…Lesions in both groups were graded by their practitioner as ‘active’ at over 60% of visits. This is likely a direct consequence of the PRN treatment approach adopted in most Italian centres during the study period, calling for close follow‐up of the lesion and re‐treatment only when there was new exudative activity 27,28 . Treatment paradigms have shifted towards the T&E regimen in recent years as evidence of its long‐term benefits became available 29,30 …”

Section: Discussionmentioning

confidence: 99%

“…This is likely a direct consequence of the PRN treatment approach adopted in most Italian centres during the study period, calling for close follow-up of the lesion and re-treatment only when there was new exudative activity. 27,28 Treatment paradigms have shifted towards the T&E regimen in recent years as evidence of its long-term benefits became available. 29,30 Unlike PCV in Asian populations, which has been associated with worse treatment outcomes and is more likely part of the pachychoroid spectrum, 6,7,[12][13][14]31,32 features of typical AMD are much more frequent in PCV affecting Caucasian patients, 7,10,32 placing PCV on a continuum of possible nAMD presentations rather than constituting a clearly separate entity.…”

Section: Discussionmentioning

confidence: 99%

Twenty‐four‐month real‐life treatment outcomes of polypoidal choroidal vasculopathy versus type 1 macular neovascularization in Caucasians

Airaldi,

Invernizzi,

Nguyen

et al. 2023

Clinical Exper Ophthalmology

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BackgroundTo compare 24‐month real‐world outcomes of Vascular Endothelial Growth Factor (VEGF) inhibitors for Polypoidal Choroidal Vasculopathy (PCV) and type 1 Macular Neovascularization (MNV) in a Caucasian population.MethodsRetrospective analysis from a prospectively designed observational database. Data from Italian centres participating in the Fight Retinal Blindness! (FRB!) project were collected. Treatment‐naïve PCV or type 1 MNV commencing treatment after January 2009 were included. The primary outcome was 24‐month visual acuity (VA) change; other outcomes included baseline characteristics, number of anti‐VEGF injections, time to lesion inactivation and proportion of active visits.ResultsA total of 322 eyes (114 PCVs) from 291 patients were included. Median [Q1, Q3] VA at baseline was comparable (70 [55, 75.8] vs. 70 [58.8, 75] letters, p = 0.95). Adjusted VA change at 2 years was higher in PCV (mean [95% CI], +1.2 [−1.6, 4.1] vs. −3.6 [−6, −1.2] letters, p = 0.005). PCV received fewer anti‐VEGF injections over the first 24 months of treatment than type 1 MNV (median [Q1, Q3], 8 [5, 10] vs. 9 [7, 12.2] injections, p = 0.001), inactivated earlier (median [Q1, Q3], 235 [184, 308] vs. 252 [169, 343] days, p = 0.04) and was less frequently graded ‘active’ (62% vs. 68% of visits, p = 0.001).ConclusionsPCV had slightly better VA outcomes over 24 months of treatment than type 1 MNV after receiving less anti‐VEGF injections. These results suggest a possible overlap of the two clinical entities with similar visual prognosis in Caucasians.

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“…[9][10][11] Some investigators suggest that -if exudation can be limited by anti-VEGF therapy -the persistence or growth of MNV may even function as a nutrient source for the overlying retinal pigment epithelium (RPE) and retina and may perform the work of the original choriocapillaris ("neochoriocapillaris", neo-cc). 11,12 This may imply that MNV growth can stabilize rather than deteriorate vision in affected patients.…”

Section: Introductionmentioning

confidence: 99%

Retinal sensitivity above macular neovascularization under anti-VEGF therapy in exudative neovascular age-related macular degeneration

Pauleikhoff,

Ziegler

et al. 2024

Preprint

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Purpose: Growth of macular neovascularization (MNV) associated with the development of macular atrophy in some eyes has been observed in neovascular age-related macular degeneration (nAMD) under effective anti-vascular endothelial growth factor (VEGF) therapy. We aimed to evaluate the influence of growing MNV and macular atrophy development on the sensitivity of the overlaying retina. Methods: Prospective pilot study on nAMD patients undergoing long-term anti-VEGF therapy (IVAN treatment strategy) that had also undergone microperimetry testing. MNV extension and, if present, associated macular atrophy defined as complete retinal pigment epithelial and outer retina atrophy (cRORA) were identified on OCT volume scans and transposed onto en-face NIR images. Mesopic microperimetry performed at the same visit was superimposed. Retinal sensitivity above the MNV and the surrounding retina was compared, excluding areas of cRORA. Results: 26 eyes (19 f, 7 m; age 79.3 ± 5.7 y; fu 4.0 ± 1.8 y; 7.4 ± 2.5 inj./y) were classified into “no cRORA” group (n=11) and “cRORA” group (n=15). In the “no cRORA” group, BCVA was significantly higher, and mean retinal sensitivity above the MNV did not differ from the surrounding retina (20.9 ± 2.8 vs. 22.0 ± 2.4, p=.33), while in the “cRORA” group, a lower sensitivity above the MNV was observed (16.2 ± 3.4 vs 19.9 ± 2.0, p=.001). Conclusion: In the absence of cRORA, retinal sensitivity above the MNV did not differ significantly from that of the surrounding retina. These results support the hypothesis that MNV itself may not be detrimental if cRORA can be prevented.

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Differences in Long-Term Progression of Atrophy between Neovascular and Nonneovascular Age-Related Macular Degeneration

Cited by 8 publications

References 35 publications

Chorioretinal Atrophic Lesions Evolution in Patients with Quiescent Myopic Choroidal Neovascularization Followed for More Than 10 Years

Chorioretinal Atrophic Lesions Evolution in Patients with Quiescent Myopic Choroidal Neovascularization Followed for More Than 10 Years

Twenty‐four‐month real‐life treatment outcomes of polypoidal choroidal vasculopathy versus type 1 macular neovascularization in Caucasians

Retinal sensitivity above macular neovascularization under anti-VEGF therapy in exudative neovascular age-related macular degeneration

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