Characterization of macular neovascularization in geographic atrophy

Abstract

Purpose : To characterize macular neovascularization (MNV) developing in eyes affected by geographic atrophy (GA).

Methods : In this multicentric longitudinal study, patients previously affected by GA that developed an active MNV were included in 3 retina referral centers. Patients were investigated using structural optical coherence tomography (OCT), fundus autofluorescence, OCT-angiography, and dye angiographies. Patients were treated with ProReNata (PRN) anti-vascular endothelial growth factor (VEGF) injections and were revaluated after treatment.

Results : Among 512 patients previously diagnosed with GA, 40 eyes of 40 patients (mean age 80.8±7.9 years, mean GA area 8.73±7.39 mm²) presented with treatment-naïve exudative MNV (accounting for an estimated prevalence of 7.81%; 5.49 - 10.13, 95% confidence intervals) and thus were included in the analysis. 67.5% of MNVs were classified as type 2 MNV, 25% as type 1, 2.5% as type 3, and 5% as mixed phenotype. In 92.5% of cases, active MNV in GA showed subretinal hyperreflective material (SHRM) with or without evidence of sub-/intra-retinal hyporeflective exudation. During a mean follow-up of 28±25 months, patients were treated with 6.6±6.3 anti-VEGF injections, with 2.9±1.4 injections in the first year of treatment. No patient developed GA enlargement in the area of MNV.

Conclusions : MNVs in GA showed different multimodal imaging features and therapeutic response in comparison to previously reported features of MNV in age-related macular degeneration (AMD) without GA. For these reasons, the combined phenotype (i.e. GA with neovascular AMD) should be considered as a distinct entity in the research and clinical setting.

This is a 2021 ARVO Annual Meeting abstract.