Fibrosis, macular atrophy increase risk for vision loss in neovascular AMD
CHICAGO — Fibrosis and macular atrophy increase the risk for vision loss in patients on long-term anti-VEGF therapy for neovascular age-related macular degeneration, according to a study.
“There is no doubt that visual acuity improves with anti-VEGF treatment, at least for the first 3 years,” Giovanni Staurenghi, MD, said at Retina Subspecialty Day at the American Academy of Ophthalmology meeting. “We also know that it decreases over the years. One of the reasons could be fibrosis or macular atrophy.”
Staurenghi and colleagues assessed the cumulative incidence of fibrosis and macular atrophy in 225 eyes of 207 patients over 10 years of follow-up. Secondary outcomes included evaluation of the risk factors associated with the development of fibrosis and macular atrophy, as well as their effect on long-term visual outcomes.
Staurenghi said 141 eyes developed fibrosis and 104 eyes developed macular atrophy.
Central subfield thickness variation (P < .001), submacular hemorrhages (P = .008) and number of intravitreal injections (P = .012) were risk factors for fibrosis, while patients with a baseline best corrected visual acuity greater than 50 letters were at lower risk (P = .027). In macular atrophy, baseline BCVA of 50 letters or fewer (P < .001), central subfield thickness variation (P < .001) and intraretinal fluid (P = .03) were potential risk factors.
Eyes that developed fibrosis or macular atrophy had lower visual acuity at 10 years compared with eyes without (both P < .001).
“This supports the hypothesis that AMD patients with macular neovascularization should be promptly treated with proactive regimens,” Staurenghi said.
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Staurenghi G. Long-term effect of the anti-VEGF treatment: A 12-year experience. Presented at: American Academy of Ophthalmology meeting; Sept. 30-Oct. 3, 2022; Chicago.
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