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Ang Li, Fabiana Queiroga de Paula Araujo Silva, Jonathan E Sears, Sunil K Srivastava, Justis Ehlers, Andrew Schachat, Peter K Kaiser, Daniel F Martin, Rishi P Singh; Development of geographic atrophy in age-related macular degeneration treated with long term intravitreal injections of anti-vascular endothelial growth factor.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):897. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
While intravitreal anti-VEGF injection has become the mainstay treatment for neovascular age-related macular degeneration (nAMD), emerging studies suggest that long term use may be correlated with development of geographic atrophy (GA). No existing study reported beyond 2 years of anti-VEGF treatment to reflect real life experience of chronic therapy. The purpose of the current study is to determine prevalence and progression of GA in nAMD treated with long term anti-VEGF injections for 4 years.
This is an IRB approved retrospective chart review on patients at the Cole Eye Institute who have received anti-VEGF treatment for nAMD for at least 4 years. Eyes that developed disciform scar, RPE tear, or treated with photodynamic therapy, or laser photocoagulation were excluded. All eyes had spectral domain optical coherence tomography (SDOCT) at baseline and 6 month follow up intervals. RPE subillumination analysis was used to automate identification of atrophy by segmenting regions of increased reflectivity in the choroidal layer on OCT. Segmentation errors were manually corrected by expert raters using a standardized grading protocol. Prevalence and quantification of atrophy were measured at baseline and each 6 month follow up. Baseline demographics, BCVA, and number of anti-VEGF injections were correlated with development and progression of geographic atrophy.
25 eyes from 22 patients (83 ± 8 years, 52% males) with nAMD and 4 years of follow up with anti-VEGF injections were included in this retrospective study. Average baseline BCVA by ETDRS letters was 64.3 ± 16.5, and 62.3 ± 22.9 at end of 4 years. Average number of injections was 19.6 ± 8.4 over this period. GA was observed in 12% eyes at baseline with an average biannual growth rate of 0.2 ± 0.2 mm^2. In the 22 eyes without baseline atrophy, GA developed in 8 (36.4%) eyes by year 4 with a biannual growth rate of 0.1 ± 0.1 mm^2.
nAMD treated with long term anti-VEGF injections is correlated with development of GA in more than one third of patients without baseline atrophy. This rate is observed to be higher than prior studies with shorter follow up times, and appears to be greater than rate of natural history seen in patients with geographic atrophy without nAMD.
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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