Macular atrophy in neo-vascular AMD – incidence and risk factors related to treatment

Abstract

Purpose : To assess the development and progression of MA, according to the new Classification of Atrophy Meetings (CAM) criteria, in patients with nAMD treated with ranibizumab or aflibercept, in different administration regimens and to determine baseline predictive factors.

Methods : Retrospective study. Eyes with nAMD were assessed at baseline and 12 months after starting treatment with ranibizumab or aflibercept in one of four regimens: monthly, bimonthly, pro renata (PRN) or treat and extend (T&E). Fellow-eyes were also assessed. Multimodal evaluation was performed with spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), fundus autofluorescence (FAF) and color fundus photography (CFP). The primary outcome were the 4 types of MA, based on the AAO’s Consensus Definition for Atrophy Associated with AMD on OCT: cRORA, iRORA, cORA and iORA. Logistic regression models were built to test predictors of MA.

Results : A total of 85 eyes of 85 patients (63%female; mean age 78.5±6.3 years old) were included. The mean number of intravitreal injections was 8.3±2.5. VA improved from 55.4±16.5 letters to 60.8±17.4 letters in the endpoint (P<0.001). The prevalence of all types of MA significantly increased (P<0.0005). At baseline, 8% presented cRORA, 22% iRORA, 8% cORA and 29% iORA. In the end of follow-up, 38% evidenced cRORA, 72% iRORA, 33% cORA and 57% iORA. A significant association was observed between cRORA at 12th month and subretinal fluid height (OR 0.31 CI 95% 0.12 to 0.84, P = 0.021). The number of injections was related to cORA in the endpoint (OR 1.52 CI 95% 1.10 to 2.11, P = 0.011).

Conclusions : This is the first study to document the evolution of the different types of MA after treatment with anti-VEGF using the CAM definition, and the first to explore baseline factors related to the development of these different types of atrophy. We found that the presence of subretinal fluid at baseline seems to be protective for the development of cRORA. We also concluded that incidence of cORA is associated with a higher number of injections, independently of the drug type.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.