Abstract
Purpose :
The purpose of this report is to characterize anatomical outcomes which would influence Visual function in nAMD patients over 10 years following initiation of intravitreal anti-VEGF injections
Methods :
A retrospective cohort review of medical records was performed to collect patients who had commenced intravitreal therapy for nAMD at Moorfields Eye Hospital (MEH) before January 1, 2009. The best corrected visual acuity(BCVA) was evaluated at 10 years. Optical coherence tomography (OCT) scans and colour fundus photographs of all patients obtained at baseline and last visit were reviewed to assess morphological features, including central retinal thikness (CRT), choroidal neovascular membrane (CNV) type, intraretinal fluid (IRF), subretinal fluid (SRF), geographic atrophy (GA) and fibrotic scar.
Results :
Fifty-sex patients received intravitreal injections for nAMD and were followed-up for ten-year duration. The mean BCVA at 10 years was 42.9 ± 27.0 ETDRS letters. Average central retinal thickness was 300.8 ± 88.8 μm at baseline and 237.1 ± 74.5 μm at 10 years, with an overall average decline of 65.3 ± 99.31 μm. An initial improvement was noticed at 6 months, was maintained until year 7(-72.6 ± 24.4 μm), followed by an increase to reach baseline values at year 9. At 10 years, 21 patients (37.5%) had IRF, 5 (8.9 %) had SRF, and 3 (5.3%) had both IRF and SRF, while 43 (76.8%) and 33 (58.9%) presented GA and fibrotic scar, respectively. In patients who achieved a poor final BCVA (≤35 letters) at 10 years; fibrotic scar at the foveal center was accounting for 70% of the total, followed by foveal GA (17%) and foveal IRF/SRF (13%). Median time to GA development was 44.8 months. The development of GA was not associated with any of those covariates; gender, baseline age, baseline BCVA, baseline foveal thickness, number of injections as well as the type of CNV either positively or negatively. while the presence of IRF at baseline was found to be positively associated with GA development (HR 2.21; 95% CI 1.02-4.79), and SRF was negatively associated with GA development (HR 0.52; 95% CI 0.28-0.97).
Conclusions :
The development of fibrotic scars and GA are the main causes of poor visual outcome which is neither correlated with the baseline BCVA nor the number of injections. This could give more insight for the prognosis of this long term disease to the patients and doctors.
This is a 2020 ARVO Annual Meeting abstract.