Retinal Precursors and the Development of Geographic Atrophy in Age-Related Macular Degeneration

Klein, Michael L.; Ferris, Frederick L.; Armstrong, J.; Hwang, Thomas S.; Chew, Emily Y.; Bressler, Susan B.; Chandra, Suresh R.

doi:10.1016/j.ophtha.2007.08.030

Cited by 197 publications

(140 citation statements)

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“…Histopathological sections of GA show thinning or absence of the RPE, closure of the choriocapillaris, and degeneration of the overlying photoreceptors. The site of the initial appearance of GA is initially occupied by drusen, which are large (>125 μm in diameter) in 96% of cases (4)(5)(6) . The drusen are usually confluent, with at least two in contact, and sometimes extensive enough to form plaques of drusenoid material.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal ranibizumab and bevacizumab therapy for choroidal neovascularization in age-related macular degeneration with extensive pre-existing geographic atrophy

Amaro

Roller

2012

Arq. Bras. Oftalmol.

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Purpose: To report the response of choroidal neovascularization to intravitreal ranibizumab or bevacizumab treatment in the setting of age-related macular degeneration with extensive pre-existing geographic atrophy of the retinal pigment epithelium. Methods: This is a retrospective case series of 11 eyes in ten consecutive patients retrieved from a photographic database. The patients were treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration with pre-exis ting geographic atrophy. Patients were included if they had geographic atrophy at or adjacent to the foveal center of at least 1 disc area in size that was present before the development of choroidal neovascularization. The best corrected visual acuity and optical coherence tomography analysis of the central macular thickness were recorded for each visit. Serial injections of ranibizumab or bevacizumab were administered until there was complete resolution of subretinal fluid on optical coherence tomography. Data over the entire follow-up period were analyzed for overall visual and optical coherence tomography changes. Results: The patients received an average of 7 ± 3 intravitreal injections over the treatment period. Seven of 11 eyes had reduced retinal thickening on optical coherence tomography. On average, the central macular thickness was reduced by 72 ± 115 µm. Six of these 7 eyes had improvement of one or more lines of vision and one had no change. The average acuity change for all patients was -0.04 ± 0.46 logMAR units, which corresponded to a gain of 0.2 ± 4.4 lines of Snellen acuity. The treatment resulted in a good anatomic response with resolution of the subretinal fluid and overall stable visual acuity. Conclusions:The results of this case series suggest that the use of an intravitreal anti-vascular endothelial growth factor (VEGF) agent (ranibizumab or bevacizumab) for choroidal neovascularization in age-related macular degeneration with preexis ting geographic atrophy is effective. Our results are not as striking as published results from large-scale trials of anti-vascular endothelial growth factor therapy for subfoveal choroidal neovascularization, presumably due to the limitation in the baseline visual acuity caused by the underlying geographic atrophy. The favorable anatomic response with the resolution of subretinal fluid and stable acuity were consistent with other ranibizumab and bevacizumab studies.Keywords: Macular degeneration; Geographic atrophy; Retinal pigment epithelium, Choroidal neovascularization; Antibodies, monoclonal/therapeutic use; Retina; Antibodies, monoclonal, humanized; Tomography, optical coherence Intravitreal ranibizumab and bevacizumab therapy for choroidal neovascularization in age-related macular degeneration with extensive pre-existing geographic atrophy Avaliação da resposta da injeção intravítrea de ranibizumab e bevacizumab em pacientes com neovascularização de coroide da degeneração macular relacionada à idade com atrofia geográfica extensa pré-existente

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Section: Introductionmentioning

confidence: 99%

Intravitreal ranibizumab and bevacizumab therapy for choroidal neovascularization in age-related macular degeneration with extensive pre-existing geographic atrophy

Amaro

Roller

2012

Arq. Bras. Oftalmol.

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“…1 The death of RPE and photoreceptors is slow, and the rate can vary greatly among patients, but eventually it can lead to patches of atrophy that correspond to blank spots in the central visual field, which over time can spread into the fovea and compromise visual acuity. 2 Superimposed on this slow neurodegenerative disease process is another disease process in which neovascularization (NV) occurs beneath the RPE and retina. The subgroup of AMD patients with this complication are said to have neovascular AMD (NVAMD).…”

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confidence: 99%

Lentiviral Vector Gene Transfer of Endostatin/Angiostatin for Macular Degeneration (GEM) Study

et al. 2017

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“…Large drusen (diameter: >125 lm), hyperpigmentary and hypopigmentary changes, and refractile/ crystalline deposits have been described as potential precursor lesions. 4,[20][21][22] In a clinicopathologic study, Sarks et al 7 distinguished three patterns of atrophy evolution: (1) primary age-related atrophy (no obvious association with drusen), (2) drusen-related atrophy (association with regressing drusen or drusen clusters), and (3) other causes (e.g., resolution of pigment epithelial detachment). Furthermore, the Age-Related Eye Disease studies (AREDS 1 and AREDS 2) have reported the development of atrophy based on definitions by CFP in eyes with early and intermediate AMD (iAMD).…”

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confidence: 99%

Multimodal Imaging Patterns for Development of Central Atrophy Secondary to Age-Related Macular Degeneration

Thiele

Pfau

Larsen

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To evaluate the development of central atrophy in eyes with age-related macular degeneration (AMD).METHODS. Six-year longitudinal multimodal retinal imaging data (MODIAMD study) from 98 eyes of 98 subjects with non-late-stage AMD in the study eye at baseline were analyzed for the presence of central atrophy at each annual follow-up visit. Development, manifestation, and further progression of complete retinal pigment epithelium and outer retinal atrophy (cRORA) by multimodal imaging data were compared with atrophy detection based on color fundus photography only.RESULTS. Seventeen study eyes with development of central cRORA within 6 years (cumulative rate: 17.4%) were identified based on multimodal imaging. In 10 (60%) of these eyes, presence of central manifest atrophy was initially not detectable by color fundus photography. In six (35%) eyes, central cRORA occurred by the spread of existing paracentral atrophy toward the fovea. Drusen-associated atrophy development was noted in eight eyes. In two eyes, atrophy development was associated with refractile deposits, while only pigmentary changes in absence of large drusen or refractile deposits were detectable before atrophy occurrence in one eye.CONCLUSIONS. The earlier and more precise detection of central cRORA by multimodal imaging as compared to atrophy detection solely based on color fundus photography allows for more accurate detection and identification of different pathways for atrophy development. In accordance with previous clinical and histopathologic reports, the results confirm that different precursor lesions may independently proceed to central cRORA in AMD.

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Retinal Precursors and the Development of Geographic Atrophy in Age-Related Macular Degeneration

Cited by 197 publications

References 21 publications

Intravitreal ranibizumab and bevacizumab therapy for choroidal neovascularization in age-related macular degeneration with extensive pre-existing geographic atrophy

Intravitreal ranibizumab and bevacizumab therapy for choroidal neovascularization in age-related macular degeneration with extensive pre-existing geographic atrophy

Lentiviral Vector Gene Transfer of Endostatin/Angiostatin for Macular Degeneration (GEM) Study

Multimodal Imaging Patterns for Development of Central Atrophy Secondary to Age-Related Macular Degeneration

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