Abstract
Purpose :
To evaluate the rate of growth of macula atrophy amongst neovascular age-related macular degeneration (nvAMD) patients treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) compounds, and to identify associated risk factors.
Methods :
Clinical and optical coherence tomographyfindings were retrieved for nvAMD cases treated with intravitreal anti-VEGF compounds using a treat-and-extend protocol. The area and number of atrophy foci were measured at baseline and at 8 years. Growth was correlated with clinical data and genotypes for the major risk alleles for AMD in the CFH (rs1061140), and C3 (rs2230199) genes.
Results :
From 276 eligible eyes in 206 patients, 92 eyes (33.3%) in 76 patients (36.9%) had a follow-up period of ≥8 years and were included in this study. The mean age of the study participants was 73.9±7.9 years, 54.9% were female. An average of 7.1±3.2 (mean ± SD) anti-VEGF injections were administered per year. Prevalence of atrophy increased from 28.3% at baseline to 78.3% at 8 years. The mean square root transformation of atrophy increased from 0.36±0.72mm at baseline to 2.01±1.83mm at final visit, p<0.0001, hence an average growth rate of 0.25±0.22mm/year. Median survival time to the development of atrophy was 2 years (95% confidence interval 0.83-3.17 years). The median number of atrophic foci per eye increased from 0 (interquartile range (IQR) 0-1) at baseline to 4 (IQR 0-9) at 8 years, p<0.0001. Atrophy growth was correlated with size and number of atrophic spots at baseline (spearman’s rho = 0.357 and 0.383, p<0.0001 in both cases, respectively). The growth of macula atrophy wasn’t correlated with age, the number of intravitreal injections, or macula neovascularization (MNV) type. We found no correlation between the macula atrophy growth and the number of CFH and/or C3 risk alleles carried by the patient.
Conclusions :
nvAMD eyes under anti-VEGF therapy for 8 years developed a 5-fold increase in size of macula atrophy. Atrophy growth was correlated to baseline size and number of atrophic foci. Atrophy growth didn’t correlate with age, intravitreal injections, MNV type, or major risk alleles for AMD.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.