Effect of Anti-VEGF Therapy on the Natural History of Active Disciform Scar Secondary to Age-Related Macular Degeneration: A Pilot Study

Abstract

Purpose: : To determine the effect of intravitreal anti-VEGF therapy on visual acuity (VA), fluorescein angiography (FA) leakage, scar size and atrophy size, in patients with active disciform scar secondary to AMD presenting with reactivation of choroidal neovascularization (CNV).

Methods: : A retrospective, interventional study was conducted of patients with disciform scar secondary to AMD, presenting with reactivation of CNV and treated with intravitreal anti-VEGF injections. Baseline and final VA, FA leakage size, disciform scar size and atrophy size were measured. Statistical analysis of the change was undertaken for each parameter.

Results: : We identified 14 eyes of 14 patients with a mean age of 78 ± 9.5 years (range 59-92 years); 9 males and 5 females. Two eyes were treatment naïve, and 12 eyes had other treatments prior to the diagnosis of a disciform scar. Each eye received a mean of 3.5 ± 2.2 injections (96% Avastin, 4% Macugen). Mean follow up was for 11.4 ± 6.5 months. Mean VA improved from 1.58 ± 0.46 logMAR at baseline to 1.28 ± 0.37 logMAR at last follow up (p=0.002). Initial FA demonstrated leakage in 100% of eyes with a mean size of 3.19 ± 3.04 disc areas (DA) (5.63 ± 5.37 mm²), and final FA showed leakage in 43% of eyes with a mean size of 0.92 ± 1.64 DA (1.62 ± 2.9 mm²) (p=0.035). Mean initial scar size was 3 ± 2.56 DA (5.30 ± 4.52 mm²), and mean final scar size was 2.61 ± 2.77 DA (4.61 ± 4.9 mm²) (p=0.2563). Mean initial atrophy size was 4.02 ± 5.3 DA (7.03 ± 9.4 mm²), and mean final atrophy size was 4.68 ± 4.5 DA (8.27 ± 7.9 mm²) (p=0.1423).

Conclusions: : In this pilot study, intravitreal anti-VEGF monotherapy significantly improved visual acuity in patients with active disciform scars secondary to AMD. This improvement was accompanied by a significant reduction in the amount and size of leakage on FA. The decrease in the scar size was accompanied by an increase in the size of the atrophy. Patients with disciform scars secondary to AMD should be followed for reactivation, and treatment should be considered to limit the amount of scarring, which may prevent the progression of severe visual loss.

Keywords: age-related macular degeneration • retina • choroid: neovascularization