Progression of macular atrophy on long-term anti-VEGF therapy for AMD
Reviewed by Sofia Rokerya

This retrospective study evaluated the progression of macular atrophy in 53 eyes of 53 patients receiving AntiVEGF Therapy for age-related macular degeneration (nAMD), for at least six years. None of the patients had any macular atrophy (MA) at presentation. MA was evaluated on an annual basis using NIR images, while all available optical coherence tomography (OCT) images were used to confirm that the atrophic area fulfilled the criteria proposed by the Classification of Atrophy Meetings (CAM) group for complete retinal pigment epithelium and outer retinal atrophy. Incidence and progression of MA were evaluated. The images were independently analysed by two retinal graders. The data of the cohort is as follows; Age 81.36 ±7.91 years, M: F 23:30. The majority of the study population (80.36%) was diagnosed with occult choroidal neovascularisation (CNV); CNV (type 1/2/3) 44/6/3 respectively. The mean number of anti-VEGF injections given during the study period was 24.4 ±13.6 and the total duration of treatment was 7.34 ±1.54 years. BCVA at baseline was 0.38 ±0.27 log MAR, while at the final visit, this was 0.60 ±0.49 log MAR (p = 0.731). During the median follow-up of seven years, 28 out of 53 (52.83%) eyes developed incident MA. The cumulative annual incidence of MA was 1.89% by the first year of follow-up rising to 18.87% by the second year, 32.08% by the third year, 39.62% by the fourth year, 49.06% by the fifth year, and 50.94% by the sixth year. Median time to MA development was 5.62 years. In patients who developed MA, mean MA area increased from zero at baseline to 5.66 ±7.18 mm2 at the final visit. MA progression does not appear to be significantly associated with age (R = 0.055; p = 0.784), gender (R = 0.113; p = 0.576), BCVA (R = 0.168; p = 0.404), and total number of injections (R = 0.133; p = 0.255). Limitations: retrospective; lack of a control cohort; small sample size.

Progression of macular atrophy in patients receiving long-term anti-VEGF therapy for age-related macular degeneration: real-life data.
Blazakia S, Blavakisa E, Smoustopoulos B, et al.
OPHTHALMOLOGICA
2022;245(2):152-60.