Abstract
BackgroundTo report a series of age-related macular degeneration (AMD) patients in whom progression to geographic atrophy (GA) in one eye receiving frequent intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) therapy for type 1 neovascularization (NV) was slower than that of the fellow eye with non-neovascular AMD.MethodsRetrospective, observational case series examining the clinical course and GA progression rate in four consecutive patients in which one eye harbored type 1 neovascular AMD and was receiving anti-VEGF therapy, while the fellow eye manifested signs of non-neovascular AMD only. Eligibility criteria included anti-VEGF therapy duration of over 4 years and over 50 injections. Lesion evolution was documented via multimodal imaging. GA at baseline and final visits was quantified and GA progression rate for each eye was determined.ResultsFour consecutive patients were followed for a mean interval of 94 months (range 62–120). One eye harbored type 1 NV while the fellow eye remained non-neovascular. The former received a mean of 65.5 ± 15.2 anti-VEGF injections. Mean rate of GA progression in non-neovascular eyes was 0.076 ± 0.024 mm2/month and in type 1 NV eyes was 0.004 ± 0.005 mm2/month. Difference in GA progression rate between type 1 and non-neovascular eyes was found to be statistically significant (P = 0.001).ConclusionsThese findings support previous hypotheses that, unlike type 2 and 3 lesions, type 1 NV may represent a neovascular AMD subtype more resilient to GA formation. This may have implications for anti-VEGF regimens in the management of type 1 NV.
Highlights
To report a series of age-related macular degeneration (AMD) patients in whom progression to geo‐ graphic atrophy (GA) in one eye receiving frequent intravitreal injections of anti-vascular endothelial growth factor therapy for type 1 neovascularization (NV) was slower than that of the fellow eye with non-neovascular AMD
Geographic atrophy (GA) is a form of advanced agerelated macular degeneration (AMD) and is a term that is used to denote the occurrence of retinal pigment epithelium (RPE), photoreceptor and choriocapillaris loss [1, 2]
Results from the comparison of AMD treatment trials (CATT) study and Inhibition of VEGF in age-related choroidal neovascularization (IVAN) trial have raised some concerns regarding the effects of long-term anti-vascular endothelial growth factor (VEGF) therapy on the outer retina [8]
Summary
To report a series of age-related macular degeneration (AMD) patients in whom progression to geo‐ graphic atrophy (GA) in one eye receiving frequent intravitreal injections of anti-vascular endothelial growth factor (antiVEGF) therapy for type 1 neovascularization (NV) was slower than that of the fellow eye with non-neovascular AMD. Results from the comparison of AMD treatment trials (CATT) study and Inhibition of VEGF in age-related choroidal neovascularization (IVAN) trial have raised some concerns regarding the effects of long-term anti-vascular endothelial growth factor (VEGF) therapy on the outer retina [8]. The results from both of these studies have suggested that the duration and frequency of anti-VEGF therapy may be related to the risk of new GA and GA progression. Expanding our understanding about the clinical and multimodal imaging (MMI) characteristics of NV subtypes and the relationships that they bear to the development of GA is likely to aid with a more individualized patient management
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