Atrophy and anti-VEGF
Reviewed by Saruban Pasu

The aim of this study was to investigate treatment factors, along with ocular and systemic factors for their association with macular atrophy (MA) incidence in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF aflibercept or ranibizumab according to their individualised need. The number of injections according to the Observe-and-Plan regimen over two years was recorded. Imaging data were collected from multimodal retinal imaging for baseline and at the end of the two-year study protocol. The diameter had to be at least 250µm to be considered as atrophy. A total of 149 eyes (149 patients) were included in the present analysis: 70 eyes received aflibercept injections, and 79 eyes were treated with ranibizumab injections. Forty-two percent developed de novo atrophy by year two. The atrophic lesion area was ≤1mm2 in 44% of eyes and >5mm2 in only 11% of eyes. Of the 63 eyes with de novo atrophy, it was co-localised within the area of the baseline choroidal neovascularisation (CNV) complex in 48 eyes (76%), located purely outside the CNV complex in six eyes (10%), and the location was mixed in nine eyes (14%). A significant association (p<0.05) was observed between MA incidence and fewer injections, lower baseline visual acuity, the presence of retinal angiomatous proliferation (RAP) type neovascularisation, the presence of reticular pseudodrusen, the presence of depigmentation of the retinal pigment epithelium (RPE), the presence of intraretinal cysts at baseline, the absence of subretinal fluid at baseline and thinner subfoveal choroidal thickness. The drug type did not show any association with MA incidence.

Macular atrophy incidence in anti-vascular endothelial growth factor-treated neovascular age-related macular degeneration. Risk factor evaluation for individualized treatment need of ranibizumab or aflibercept according to an observe-and-plan regimen.
Mantel I, Dirani A, Zola M, et al.
RETINA
2019;39(5):906-17.