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Justin Shaw, Philip Scharper; The Role of Anti-VEGF Therapy in the Development and Progression of Geographic Atrophy in Patients with Wet Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6295.
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© ARVO (1962-2015); The Authors (2016-present)
Geographic atrophy (GA) is a prominent cause of visual disability among patients with both wet and dry age related macular degeneration (AMD). Recent two year results of the CATT trial have raised the question of whether anti-VEGF injections may contribute to the development of GA. We evaluated 6 patients with both wet and dry AMD to determine if there was an increased incidence of GA in the anti-VEGF treated eye.
We retrospectively evaluated twelve eyes of six patients undergoing anti-VEGF injections for wet AMD in one eye who had dry AMD in the fellow eye. All 6 eyes with wet AMD underwent monthly anti-VEGF injections for at least 24 months. Both autofluorescence and color fundus photography were used to evaluate for GA at the beginning and end of the follow up period. The greatest horizontal (H) and vertical (V) diameters of GA were measured using the linear measuring tool in EyeRoute viewing software (ANKA Systems, Inc., Virginia).
Mean follow up time was 31.8 months (range: 28-38). Eyes with wet AMD underwent a mean of 29 anti-VEGF injections (range: 23-37). Only one of the eyes with wet AMD (16.7%) had pre-existing GA measuring 1.51 mm (V) x 0.85mm (H), which increased in size to 1.88mm (V) x 0.97mm (H) (increase in 24.5% V and 14.1% H, respectively) over the follow up period. Two eyes with wet AMD (33%) had no GA at the initiation of therapy but subsequently developed GA. The first developed an area of GA measuring 1.72mm (V) x 1.33mm (H); the second developed GA measuring 0.94mm (V) x 0.79mm (H). None of the fellow eyes with dry AMD had either pre-existing GA or developed GA. Three eyes treated for wet AMD (50%) also did not display any evidence of GA either prior to or during the follow up period.
Eyes with wet AMD treated with anti-VEGF agents over a prolonged period appear to be at higher risk for both the development and progression of GA. Additional prospective, high power studies are needed to determine whether this is secondary to the natural history of wet AMD and regressed CNV versus a retinal pigment epithelial toxicity caused by anti-VEGF agents.
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