Geographic Atrophy in Patients Receiving Anti-Vascular Endothelial Growth Factor for Neovascular Age-Related Macular Degeneration

Abstract

 

Purpose

 

To examine factors associated with the occurrence and growth of geographic atrophy (GA) in eyes with treatment-naïve neovascular age-related macular degeneration (AMD) receiving intravitreal anti-vascular endothelial growth factor (VEGF) therapy.

 

Methods

 

We retrospectively identified consecutive patients with treatment-naïve neovascular AMD who initiated anti-VEGF therapy with a single physician on a treat and extend regimen between Jan 2007 and Nov 2012. Additional inclusion criteria were age over 50 years, visual acuity of 20/20 to 20/800, absence of permanent structural damage to the central fovea, and a minimum of 12-months of follow-up. Two independent graders identified areas of GA using near infrared reflectance imaging and spectral domain optical coherence tomography (SD-OCT) at baseline and last follow-up. Neovascular (NV) lesion subtypes were classified based on fluorescein angiography (FA) as occult choroidal neovascularization (CNV), classic CNV, retinal angiomatous proliferation (RAP), or mixed CNV, and by FA combined with SD-OCT as types 1 (sub-retinal pigment epithelium), 2 (subretinal), 3 (intraretinal), or mixed NV.

 

Results

 

91 patients (94 eyes), mean (±SD) age 81.7 (±8.5) years old, fit the inclusion criteria. The mean (±SD) follow-up duration was 28.5 (±10.7) months, during which a mean (±SD) number of 17.4 (±9.0) injections were given. The proportion of eyes that experienced GA growth were 10/36 (27.8%), 4/7 (57.1%), 27/35 (77.1%), and 11/16 (68.7%) in type 1, 2, 3, and mixed NV, respectively. In comparison, with the FA-only classification, the proportion of eyes with GA growth were 19/44 (43.2%), 4/11 (36.4%), 23/31 (74.2%), and 6/8 (75.0%) in occult CNV, classic CNV, RAP, and mixed CNV, respectively. Using both FA and SD-OCT to classify NV significantly improves the goodness of fit in the correlation between GA growth and neovascular lesion type (p<0.001). The odds of developing GA were significantly lower in eyes with type 1 NV comparing to eyes with other lesion types (p<0.001).

 

Conclusions

 

Treatment-naïve eyes with neovascular AMD and type 1 NV at baseline were less likely to develop GA compared to eyes with other lesion types. GA progression was slowest in eyes with type 1 NV. The correlation between GA growth and subtype of NV is stronger when eyes are classified with FA combined with SD-OCT than with FA alone.

 

Keywords: 412 age-related macular degeneration • 453 choroid: neovascularization • 688 retina