June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Topographic Analysis of Choroidal Neovascularization (CNV) and Macular Atrophy (MA) in Neovascular Age-related Macular Degeneration (NVAMD): Findings from TREX-AMD Trial
Author Affiliations & Notes
  • Nizar Saleh Abdelfattah
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
  • Amir H Hariri
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
  • Mayss Al-Sheikh
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
  • Sean Pitetta
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
  • Adel Ebraheem
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
  • Srinivas R Sadda
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
  • Charles Clifton Wykoff
    Retina Consultants of Houston, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States
  • Footnotes
    Commercial Relationships   Nizar Abdelfattah, None; Amir Hariri, None; Mayss Al-Sheikh, None; Sean Pitetta, None; Adel Ebraheem, None; Srinivas Sadda, Allergan (F), Allergan (C), Carl Zeiss Meditec (F), Genentech (F), Genentech (C), Iconic (C), Novartis (C), Optos (F), Optos (C), Thrombogenics (C); Charles Wykoff, ALCON (F), ALIMERA SCIENCES (C), ALLEGRO OPHTHALMICS (F), ALLERGAN (R), ALLERGAN (F), AMPIO PHARMACEUTICALS (F), APELLIS PHARMACEUTICALS (F), BAYER (F), CLEARSIDE BIOMEDICAL (F), D.O.R.C. (C), DRCR NETWORK (F), GENENTECH (F), OCONIC THERAPEUTICS (F), ONL THERAPEUTICS (C), ONL THERAPEUTICS (I), OPHTHTECH (F), REGENERON PHARMACEUTICALS (F), REGENERON PHARMACEUTICALS (R), THROMBOGENICS (F), TYROGENEX (F), VALEANT (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 53. doi:
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      Nizar Saleh Abdelfattah, Amir H Hariri, Mayss Al-Sheikh, Sean Pitetta, Adel Ebraheem, Srinivas R Sadda, Charles Clifton Wykoff; Topographic Analysis of Choroidal Neovascularization (CNV) and Macular Atrophy (MA) in Neovascular Age-related Macular Degeneration (NVAMD): Findings from TREX-AMD Trial. Invest. Ophthalmol. Vis. Sci. 2017;58(8):53.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To identify the degree of topographic correspondence between MA areas graded on fundus auto-fluorescence (FAF) and spectral domain optical coherence tomography (SD-OCT) and the area of CNV lesion as graded on fluorescein angiography (FA).

Methods : TREX-AMD (NCT01748292) is a prospective randomized clinical trial which included 60 patients with treatment-naive NVAMD treated in one study eye with monthly or treat-and-extend (TREX) ranibizumab and followed for 18 months. Areas of MA at M-18 were graded semi-automatically on FAF using Region Finder and with the guidance of SD-OCT. CNV lesions were graded manually on the FA images using GRADOR, and various lesion components including classic and occult CNV (CCNV and OCNV) were delineated. FAF and FA images were equalized in scale and registered to form an image stack using Adobe Photoshop in order to assess the topographical overlap between the various CNV lesion components and MA (Figure-1).

Results : The final analysis cohort was comprised of 44 eyes that had evidence of MA at M-18. Two eyes were excluded because of the lack of gradable FA images. The remaining 42 eyes consisted of 26 study eyes that had NVAMD at BSL and 16 fellow control eyes. Out of the 42, 7 eyes had no MA at BSL yet developed MA by M-18 (6 study, 1 control). MA appeared by M-18 in areas corresponding to BSL CCNV in 8/22 eyes (36.4%), in areas of BSL OCNV in 9/22 (40.9%), and in both areas of OCNV and CCNV in 5/22 (22.7%) with the overlap area being more congruous with CCNV than the OCNV (Table-1). MA areas at BSL were located in areas corresponding to BSL CCNV in 10/14 eyes (71.4%), in areas of BSL OCNV in 8/14 (14.3%), and in both areas of OCNV and CCNV in 2/14 (10%) with the overlap area being more congruous with CCNV than the OCNV. Among eyes that had MA and CNV at BSL but with no overlap (n=6), 3 eyes (50%) progressed to involve the areas with BSL CNV. Six study eyes had no MA at BSL but developed MA at M-18 and all developed MA in regions in which CNV was noted at BSL (Table-1).

Conclusions : MA is a common finding in patients with treatment-naïve NVAMD. MA tends to develop in the same areas where CNV is noted to be present. De novo MA tends to appear in areas of CNV, especially regions of classic CNV lesions. These findings may provide insight into the pathophysiology of atrophy in the setting of CNV.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

 

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