Geographic atrophy in patients receiving anti-vascular endothelial growth factor for neovascular age-related macular degeneration

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Retina, Vol: 35, Issue: 2

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Xu, L.; Mrejen, S.; Jung, J. J.; Gallego-Pinazo, R.; Thompson, D.; Marsiglia, M.; Freund, K. B.
Aged; 80 and over;; Angiogenesis Inhibitors/*therapeutic use;; Antibodies; Monoclonal; Humanized/therapeutic use;; Bevacizumab;; Cohort Studies;; Female;; Fluorescein Angiography;; Follow-Up Studies;; Geographic Atrophy/*diagnosis/physiopathology;; Humans;; Intravitreal Injections;; Male;; Ranibizumab;; Receptors; Vascular Endothelial Growth Factor/therapeutic use;; Recombinant Fusion Proteins/therapeutic use;; Retrospective Studies;; Tomography; Optical Coherence;; Vascular Endothelial Growth Factor A/*antagonists & inhibitors;; Visual Acuity/physiology;; Wet Macular Degeneration/classification/*drug therapy/physiopathology; Ophthalmology
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PURPOSE: To examine factors associated with the apparent growth of geographic atrophy (GA) in a consecutive series of eyes with treatment-naive neovascular age-related macular degeneration receiving intravitreal anti-vascular endothelial growth factor therapy on a treat-and-extend regimen. METHODS: This was a retrospective cohort study. Two independent graders identified areas of GA using near-infrared reflectance imaging and spectral domain optical coherence tomography (SD-OCT). Neovascular lesion subtypes were classified based on fluorescein angiography (FA) as occult choroidal neovascularization, classic choroidal neovascularization, retinal angiomatous proliferation, or mixed choroidal neovascularization, and by the anatomical classification system which utilizes FA and SD-OCT as Types 1 (sub-retinal pigment epithelium), 2 (subretinal), 3 (intraretinal), or mixed neovascularization. RESULTS: Ninety-one patients (94 eyes) fit the inclusion criteria, of which 52 eyes (55.3%) experienced apparent GA growth. The odds of developing apparent GA were significantly lower in Type 1 neovascularization compared to the other lesion types (P < 0.001). Using both FA and SD-OCT to classify neovascular age-related macular degeneration significantly improves the goodness of fit in the correlation between apparent GA growth and baseline neovascular lesion type (P < 0.001). CONCLUSION: Treatment-naive neovascular age-related macular degeneration eyes with Type 1 neovascularization at baseline were less likely to develop GA than eyes with other types. The correlation between apparent GA growth and subtype of neovascularization is stronger when lesions are classified with an anatomic grading that utilizes both FA and SD-OCT.