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Nizar Saleh Abdelfattah, Hongyang Zhang, David S Boyer, Srinivas R Sadda; Macular Atrophy in Patients with Neovascular Age Related Macular Degeneration Undergoing Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):892.
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To define the frequency and quantify the progression of Macular Atrophy (MA) in neovascular Age-related Macular Degeneration (AMD) patients undergoing treatment with anti-VEGF therapy over 2 years.
Sixty-six eyes of 49 patients (86 ± 7.7 years, 63% female) diagnosed with wet AMD were included in this retrospective study. Eyes that received photodynamic therapy or laser treatment were excluded. All eyes were imaged at baseline and after 2 years with the Cirrus SDOCT using a 512×128 macular cube scan protocol centered on the fovea. OCT en-face fundus images were obtained for each 3D data set using the FDA-cleared Advanced RPE Analysis software, which automatically identifies atrophic areas by segmenting regions of increased reflectivity in en-face choroidal slab images. Segmentation results errors were manually corrected by trained Doheny Image Reading Center graders. The prevalence rates of atrophy at baseline and at 2-years follow-up, as well as enlargement rates were computed. Baseline demographic factors, and types and numbers of anti-VEGF injections received over time were correlated with the development and enlargement of atrophy.
MA was noted at baseline in 26 (40%) of eyes, and progressed in all eyes over the next two years. Among the 40 eyes without atrophy at baseline, MA developed by 2 years in 13 eyes (33% of eyes without MA at baseline). Of note, 27 eyes (41% of overall cohort) never developed atrophy during the course of the study. Among eyes with atrophy at baseline, the annual growth rate of MA was found to be 1.01 ± 1.26 mm2. A multiple regression analysis was performed to evaluate the influence of gender, age, smoking status, medication injected and number of injections, on MA. The studied variables could not significantly predict development or progression of MA, F (0.73, 13) = 0.378, p = 0.86, R2 = 0.05. However, the study was not powered to detect small effects.
Macular atrophy is a frequent finding in eyes with wet AMD both before and after anti-VEGF therapy. The frequency of new atrophy (33% at 2 years) after starting therapy was similar to the rates reported in CATT, IVAN, and HARBOR. The rate of atrophy enlargement appears to be similar to that reported for MA in the absence of choroidal neovascularization. Advanced RPE analysis using the Cirrus HD-OCT appears to be a useful tool for longitudinal studies of atrophy in this setting.
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