Incidence, Characteristics and Clinical Outcomes of Macular Neovascularization in Extensive Macular Atrophy with Pseudodrusen-like Appearance (EMAP).

Abstract

Purpose : To report the incidence, imaging features, and clinical outcomes of macular neovascularization (MNV) in patients with extensive macular atrophy with pseudodrusen-like appearance (EMAP).

Methods : A retrospective, multicenter, observational study, including 158 eyes from 79 EMAP patients (53 females) with a mean age of 56.7±4.9 years at baseline and a follow-up of 38.7+40.1 months. Demographic and clinical data were reviewed by two experienced ophthalmologists at baseline and each follow-up visit.
The type and location of MNV were determined using various imaging modalities, including optical coherence tomography (OCT), fluorescein and indocyanine green angiography, and OCT angiography. Discordant measurements were resolved by a third senior grader.
All analyses were conducted using R software version 4.1.1. Significance was set at p<0.05 and all tests were two-sided. Kaplan-Meier estimates were used to calculate the incidence of MNV in EMAP patients over the follow-up.

Results : The incidence rate of MNV was estimated to be 2.73 per 100 person-years, with an absolute incidence of 8.9% (14/158). The onset of MNV was more frequently observed with a total RPE atrophy inferior than 12 mm² (8/14, 57.1%) and superior ti 21 mm² (4/14, 28.6%). MNVs were typically classified as type 2 (12 eyes, 85.7%), located in the subfoveal region (9 eyes, 64.3%) and detected bilaterally (4/10 patients, 40%). The affected eyes received a mean of 3.4+4.5 intravitreal anti-vascular endothelial growth factor (VEGF) injections.
The onset of MNV did not significantly affect the rate of BCVA loss (-4.8+7.6 vs -4.9+6.1 ETDRS letters/year; p=0.46) and of RPE atrophy enlargement (4.1+2.2 vs 3.4+2.0 mm²/year; p=0.32) when compared with eyes without signs of MNV.

Conclusions : Our study identified an 8.9% absolute incidence of MNV in a large cohort of patients affected by EMAP. MNVs were predominantly classified as type 2 lesions and located subfoveally, however, their onset did not seem to be associated with worse clinical outcomes. This finding may be attributed to the successful response to anti-VEGF therapy of affected eyes or to the rapid progression towards foveal atrophy in cases without MNV. Further research is warranted to determine predictors of MNV development and poor visual outcomes in EMAP patients.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.