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Ferreira AM, Vilares-Morgado R, Lima-Fontes M, Falcão M, Falcão-Reis F, Carneiro Â. Chorioretinal Atrophic Lesions Evolution in Patients with Quiescent Myopic Choroidal Neovascularization Followed for More Than 10 Years. Clin Ophthalmol 2024; 18:1381-1390. [PMID: 38770398 PMCID: PMC11104444 DOI: 10.2147/opth.s461515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose To evaluate the progression of chorioretinal atrophic areas associated with myopic choroidal neovascularization (CNV) in high myopic patients followed by a minimum period of 10 years. Patients and Methods Patients with myopic CNV lesions that achieved clinical and structural remissions over 10 years of follow-up were included. Medical records were reviewed for CNV characterization and treatment, best-corrected visual acuity at baseline (BCVA0), immediately after the last treatment (BCVA1) and at the latest visit (BCVA2). Fundus autofluorescence (FAF) was used to quantify the amount of atrophic area increase per year associated with the treated myopic CNV lesion. The first FAF performed after treatment suspension (FAF1) was compared with the most recent exam (FAF2). Results Thirty-six eyes from 36 patients were included. Mean total follow-up was 12.38 ± 2.68 years. Mean number of intravitreal injections (IVI) was 12.50 ± 12.40 and 25% of the eyes had previous treatment with photodynamic therapy (PDT). Mean improvement between BCVA0 and BCVA1 was 5.58 ± 15.98 letters (p < 0.001). However, a drop of 8.03 ± 12.25 letters was noticed between BCVA1 and BCVA2. FAF1 was 6.34 ± 4.92mm2 and increased to 9.88 ± 7.56mm2 (3.54 ± 3.79mm2 variation p < 0.001). The mean growth rate of the atrophic area was 0.89 ± 0.84mm2 per year. BCVA2 negatively correlated with FAF2 (k = -0.498, p = 0.002) being worse in patients with higher atrophic area growth rate (k = -0.341, p = 0.042). Eyes treated with PDT needed less IVI (5.89 ± 5.21 vs 14.70 ± 13.36, p = 0.008) but had larger FAF1 (9.80 ± 5.33 vs 5.19 ± 4.27, p = 0.013) and FAF2 (16.05 ± 7.10 vs 7.83 ± 6.63, p = 0.003). Hypothyroidism was associated with higher atrophy growth rate (1.55 ± 1.15 vs 0.73 ± 0.67, p = 0.016). Conclusion This research demonstrates the importance of chorioretinal atrophy progression after myopic CNV lesions regression and its impact on visual prognosis, reporting a mean yearly growth of 0.89 mm2 in atrophic areas. Previous treatment with PDT and hypothyroidism were identified as risk factors associated with larger atrophic areas and worse visual outcomes.
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Affiliation(s)
| | - Rodrigo Vilares-Morgado
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Mário Lima-Fontes
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
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Pauleikhoff D, Gunnemann ML, Ziegler M, Heimes-Bussmann B, Bormann E, Bachmeier I, Yu S, Garcia Armendariz B, Pauleikhoff L. Morphological changes of macular neovascularization during long-term anti-VEGF-therapy in neovascular age-related macular degeneration. PLoS One 2023; 18:e0288861. [PMID: 38134207 PMCID: PMC10745158 DOI: 10.1371/journal.pone.0288861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To analyze the morphological changes of macular neovascularization (MNV) in exudative neovascular age-related macular degeneration under long-term intravitreal anti-vascular endothelial growth factor (VEGF) therapy in a retrospective cohort study. METHODS AND PATIENTS We evaluated 143 nAMD eyes of 94 patients (31 male, 63 female; initial age 55-97 y, mean age 75.9 ± 7.5 y), who started anti-VEGF therapy (IVAN pro re nata (PRN) protocol) between 2009-2018 and received ongoing therapy until the last recorded visit (mean follow-up 5.3 ± 2.9 y, range 1-14 y). The mean total number of injections was 33.3 ± 19.8 with 7.0 ± 2.3 injections/year. MNV size and, if present, associated complete retinal pigment epithelium (RPE) and outer retina atrophy (cRORA) size were measured on optical coherence tomography (OCT) volume scans at the initial visit and for each year of follow-up. MNV and cRORA were identified on B-scans and their respective borders were manually transposed onto the en-face near infrared image and measured in mm2. RESULTS MNV enlarged through follow-up, with a mean growth rate of 1.24 mm2 / year. The mean growth in MNV size was independent of initial MNV size, age, gender, MNV subtypes or number of injections per year. Nevertheless, a great interindividual variation in size and growth was observed. cRORA developed in association with increasing MNV size and its incidence increased linearly over follow-up. cRORA lesions also showed continuous growth by a rate of 1.22 mm2 / year. CONCLUSIONS Despite frequent long-term anti-VEGF therapy, we observed ongoing MNV growth. This is consistent with the concept that the development of MNV may be a physiological biological repair mechanism to preserve RPE and photoreceptor function, provided hyperpermeability and fluid exudation are controlled. Whether recurring low VEGF levels or other factors are responsible for MNV growth remains controversial.
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Affiliation(s)
- Daniel Pauleikhoff
- Dep. of Ophthalmology, St. Franziskus Hospital Muenster, Münster, Germany
| | | | - Martin Ziegler
- Dep. of Ophthalmology, St. Franziskus Hospital Muenster, Münster, Germany
| | | | - Eike Bormann
- Institute of Biostatistics and Clinical Research, University Muenster, Münster, Germany
| | - Isabel Bachmeier
- F. Hoffmann-La Roche Ltd., Pharma Research and Early Development, Basel, Switzerland
| | - Siqing Yu
- F. Hoffmann-La Roche Ltd., Pharma Research and Early Development, Basel, Switzerland
| | | | - Laurenz Pauleikhoff
- Dep. of Ophthalmology, Faculty of Medicine, University of Hamburg, Hamburg, Germany
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Blazaki S, Blavakis E, Chlouverakis G, Bontzos G, Chatziralli I, Smoustopoulos G, Dimitriou E, Stavrakakis A, Kabanarou S, Xirou T, Vavvas DG, Tsilimbaris MK. Evolution of macular atrophy in eyes with neovascular age-related macular degeneration compared to fellow non-neovascular eyes. Graefes Arch Clin Exp Ophthalmol 2023; 261:3425-3436. [PMID: 37566302 PMCID: PMC10667153 DOI: 10.1007/s00417-023-06168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Τo evaluate the evolution of macular atrophy (MA) in patients with neovascular AMD (nAMD), compared with their fellow eyes exhibiting dry AMD (dAMD). METHODS This retrospective study included 124 patients from three centers treated with anti-VEGF in their nAMD eye and having dAMD in the fellow eye. Patients without MA at baseline were analyzed to study the time to first MA development. Synchronous and unsynchronous time course of MA was also studied. MA was evaluated using near-infrared images, while all available optical coherence tomography (OCT) images were used to confirm the criteria proposed by the Classification of Atrophy Meetings group for complete MA. RESULTS MA first detection in nAMD eyes increased significantly from year 2 to 6 compared to dAMD eyes. Over the study's follow-up, 45.1% of nAMD-E developed MA, compared to 16.5% of fellow eyes (p < 0.001). When MA in the two eyes was compared in a synchronous paired manner over 4 years, nAMD eyes had an average MA progression rate of 0.275 mm/year versus 0.110 mm/year in their fellow dAMD eyes. Multivariate ANOVA revealed significant time (p < 0.001), eye (p = 0.003), and time-eye interaction (p < 0.001) effects. However, when MA did develop in dAMD eyes and was compared in an asynchronous manner to MA of nAMD eyes, it was found to progress faster in dAMD eyes (dAMD: 0.295 mm/year vs. nAMD: 0.176 mm/year) with a significant time-eye interaction (p = 0.015). CONCLUSIONS In this study, a significant difference in MA incidence and progression was documented in eyes with nAMD under treatment, compared to fellow eye exhibiting dAMD. Eyes with nAMD tended to develop more MA compared to fellow dAMD eyes. However, when atrophy did develop in the fellow dAMD eyes, it progressed faster over time compared to MA in nAMD eyes.
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Affiliation(s)
- Styliani Blazaki
- Department of Ophthalmology, The University of Crete Medical School, 71110, Voutes, Greece
| | - Emmanouil Blavakis
- Department of Ophthalmology, The University of Crete Medical School, 71110, Voutes, Greece
| | - Gregory Chlouverakis
- Laboratory of Biostatistics, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Dimitriou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Stavrakakis
- Department of Ophthalmology, The University of Crete Medical School, 71110, Voutes, Greece
| | - Stamatina Kabanarou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Demetrios G Vavvas
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Airaldi M, Invernizzi A, Nguyen V, Vujosevic S, Ricci F, Monaco P, Nassisi M, Barthelmes D, Gillies M, Viola F. Twenty-four-month real-life treatment outcomes of polypoidal choroidal vasculopathy versus type 1 macular neovascularization in Caucasians. Clin Exp Ophthalmol 2023; 51:799-807. [PMID: 37871984 DOI: 10.1111/ceo.14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND To compare 24-month real-world outcomes of Vascular Endothelial Growth Factor (VEGF) inhibitors for Polypoidal Choroidal Vasculopathy (PCV) and type 1 Macular Neovascularization (MNV) in a Caucasian population. METHODS Retrospective analysis from a prospectively designed observational database. Data from Italian centres participating in the Fight Retinal Blindness! (FRB!) project were collected. Treatment-naïve PCV or type 1 MNV commencing treatment after January 2009 were included. The primary outcome was 24-month visual acuity (VA) change; other outcomes included baseline characteristics, number of anti-VEGF injections, time to lesion inactivation and proportion of active visits. RESULTS A total of 322 eyes (114 PCVs) from 291 patients were included. Median [Q1, Q3] VA at baseline was comparable (70 [55, 75.8] vs. 70 [58.8, 75] letters, p = 0.95). Adjusted VA change at 2 years was higher in PCV (mean [95% CI], +1.2 [-1.6, 4.1] vs. -3.6 [-6, -1.2] letters, p = 0.005). PCV received fewer anti-VEGF injections over the first 24 months of treatment than type 1 MNV (median [Q1, Q3], 8 [5, 10] vs. 9 [7, 12.2] injections, p = 0.001), inactivated earlier (median [Q1, Q3], 235 [184, 308] vs. 252 [169, 343] days, p = 0.04) and was less frequently graded 'active' (62% vs. 68% of visits, p = 0.001). CONCLUSIONS PCV had slightly better VA outcomes over 24 months of treatment than type 1 MNV after receiving less anti-VEGF injections. These results suggest a possible overlap of the two clinical entities with similar visual prognosis in Caucasians.
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Affiliation(s)
- Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Save Sight Institute, Discipline of Ophthalmology, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Vuong Nguyen
- Save Sight Institute, Discipline of Ophthalmology, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Federico Ricci
- Department of Experimental Medicine, Tor Vergata University, Roma, Italy
| | - Pietro Monaco
- Ophthalmology Department, San Martino Hospital, Belluno, Italy
| | - Marco Nassisi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniel Barthelmes
- Save Sight Institute, Discipline of Ophthalmology, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Mark Gillies
- Save Sight Institute, Discipline of Ophthalmology, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Francesco Viola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Abdin AD, Devenijn M, Fulga R, Langenbucher A, Seitz B, Kaymak H. Prevalence of Geographic Atrophy in Advanced Age-Related Macular Degeneration (AMD) in Daily Practice. J Clin Med 2023; 12:4862. [PMID: 37510977 PMCID: PMC10381805 DOI: 10.3390/jcm12144862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/08/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To investigate the prevalence of geographic atrophy (GA) in advanced age-related macular degeneration (AMD) and the proportion of eyes that would meet the indication criteria for treatment with the first intravitreal anti-C3 agent (pegcetacoplan). METHODS This retrospective cross-sectional study included all AMD patients who visited the Macular-Retina-Centre Oberkassel in 2021. Eyes were classified according to AMD stages. Eyes with GA were divided into two groups regarding foveal involvement. Baseline factors were compared between eyes with foveal GA (FGA) and eyes with non-foveal GA (NFGA) to identify predictive factors for foveal involvement. RESULTS A total of 2033 eyes from 1027 patients were included. AMD stage was early in 296 (14.5%) cases, intermediate in 368 (18.1%) cases, and advanced in 1249 (61.4%) cases. A total of 1204 (60%) eyes had GA [932 (77%) FGA and 272 (23%) NFGA], while 125 eyes (27.4% from eyes with advanced dry AMD) met the indication criteria for treatment with intravitreal pegcetacoplan. The proportion of eyes with neovascular AMD was significantly higher in the FGA group compared to the NFGA group [598 (64.2%) vs. 152 (55.8%), p = 0.01]. CONCLUSIONS At least a quarter of eyes with advanced AMD would be suitable for the upcoming intravitreal pegcetacoplan therapy. Foveal involvement of GA in advanced AMD seems to be more likely in neovascular AMD than in dry AMD.
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Affiliation(s)
- Alaa Din Abdin
- Department of Ophthalmology, Saarland University Medical Center UKS, 66421 Homburg, Saar, Germany
| | - Machteld Devenijn
- Internationale Innovative Ophthalmochirurgie, Breyer Kaymak Klabe Augenchirurgie, 40549 Düsseldorf, Nordrhein-Westfalen, Germany
| | - Roxana Fulga
- Internationale Innovative Ophthalmochirurgie, Breyer Kaymak Klabe Augenchirurgie, 40549 Düsseldorf, Nordrhein-Westfalen, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, 66421 Homburg, Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, 66421 Homburg, Saar, Germany
| | - Hakan Kaymak
- Internationale Innovative Ophthalmochirurgie, Breyer Kaymak Klabe Augenchirurgie, 40549 Düsseldorf, Nordrhein-Westfalen, Germany
- Institute of Experimental Ophthalmology, Saarland University, 66421 Homburg, Saar, Germany
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