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Frank Picton, Katherine A Muldrew, Barney Reeves, Chris Rogers, Simon P Harding, Usha Chakravarthy, Tunde Peto, NetworcUK; Morphological features and determinants of new geographic atrophy developing in participants in the IVAN trial.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4977.
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To describe the ocular features of the geographic atrophy (GA) that developed in participants in the alternative treatments in the Inhibition of VEGF in Age-related choroidal Neovascularisation (IVAN) clinical trial.
The IVAN trial enrolled 610 participants who were randomized in a factorial design to either ranibizumab or bevacizumab given either monthly or discontinuously. GA developed during time on study in the study eye (n = 28). When GA existed at baseline, this expanded (n = 1) and new foci developed.(n = 1). The colour and fluorescein angiograms (FA) of these 30 participants were subjected to a secondary grading. The position of GA with respect to the lesion (within, contiguous or remote), its location with respect to macular quadrant, the presence of a PED were recorded and the area of GA measured at month 12 and 24. The fellow eye was assessed at baseline for presence of drusen, type of drusen, GA, and when nAMD was present, an attempt was made to ascertain if it was a retinal angiomatous proliferation (RAP).
GA had developed by the 12 month visit in 17 participants. The area of GA ranged from 0.1mm2 to 5.14 mm2 and increased in all but two eyes during the two year period. GA was located within the lesion in 42%, contiguous to the lesion in 37% and remote to the lesion in 21%. In 18 of the 30 eyes a PED was recorded at baseline. When GA developed it mainly occurred at the site of the PED (12 of 18; 66%). Examination of the fellow eye showed the predominant drusen type was large soft and found in 40% of participants. In 16% of fellow eyes foci of GA were identified at baseline. Reticular drusen were not identified in any of the fellow eyes. Approximately half of the group had nAMD in the fellow eye. An RPE tear was present in two eyes but the area devoid of RPE was distinct from the area of GA.
The association of GA with more frequent use of anti VEGF agents was raised by the comparison of age-related macular degeneration treatment trials (CATT) and confirmed by IVAN. However, the strong spatial localisation of GA to the area of pre existing PED suggests a predisposition to atrophy in eyes with this characteristic.
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