Abstract
Purpose :
AVL are infrequent manifestations of multiple disorders with undetermined risk for progression to advanced disease. We performed a retrospective, observational clinical study to determine the time to atrophy and baseline predictors for atrophy in eyes with AVL.
Methods :
Both eyes of consecutive patients registered between Jan 2009 to Jan 2014 with diagnosis of AVL confirmed by multimodal imaging and minimum follow-up of 5 years were included. AVL secondary to cuticular drusen, tractional maculopathy, paraneoplastic, infectious, and inflammatory pathologies were excluded. Serial optical coherence tomography (OCT) scans and fundus autofluorescence were graded and analysed. Main outcome measure was time to the first OCT evidence of MA stratified by presenting visual acuity (VA) and AVL lesion subtypes. Secondary outcome included risk factors for incident MA. Turnbull’s estimator was employed, and time censored at 5 years. Multivariable Weibull parametric proportional hazards models was used to assess association of risk factors with MA, following adjustment for baseline lesion type. Hazard ratios were reported with 95% CI’s.
Results :
Total 188 eyes (100 patients) met the inclusion criteria. A further 19 eyes were excluded due to atrophy or choroidal neovascularization at baseline. Incident MA was detected in 35/169 (20.7%) eyes by 5 years. Stratified by baseline VA, 42.9% eyes with VA≤ 54 letters developed atrophy within 2 years and 78.6% within 5 years of first diagnosis by multimodal imaging. In contrast, only 26.9% and 8.6% eyes with VA 55-70 and >70 letters developed atrophy by 5 years, respectively. For eyes in pseudohypopyon and vitelliruptive stage, 35.9% and 36% eyes developed MA by 5 years. In adjusted analysis, baseline factors associated with increased risk of atrophy included VA≤70 letters (HR 4.87; 95% CI 1.82-13.04), log-maximum lesion area (HR 4.59; 95% CI 2.53-8.34), presence of subretinal drusenoid deposit (HR 2.71;95% CI 1.16 -6.32) and disrupted external limiting membrane (HR 2.34; 95% CI 1.07-5.10).
Conclusions :
Baseline VA ≤70 letters attributes higher risk for atrophy and VA ≤54 accelerates time to incident MA. Baseline presence of SDD, disrupted ELM and larger lesion area led to higher risk of MA. These results provide prognostic indicators for MA in patients with AVL.
This is a 2021 ARVO Annual Meeting abstract.