Incidence of Macular Atrophy With Anti-VEGF Protocols
Ophthalmology, December 2020
Spooner et al. looked at the development and growth of macular atrophy in patients with neovascular age-related macular degeneration (AMD) who were receiving anti-VEGF therapy in pro re nata (PRN) and treat-and-extend (T&E) regimens. During the four-year study, the authors found no difference in the incidence or progression of macular atrophy by treatment regimen. They noted that the T&E approach produced better visual outcomes but required more injections.
This multicenter review included 264 consecutively treated patients (264 eyes) with AMD who were receiving anti-VEGF therapy. Each year, patients underwent fundus autofluorescence (FAF) and optical coherence tomography (OCT) imaging. Two masked graders reviewed serial FAF and OCT images to establish the presence of macular atrophy and measure changes in atrophic area over four years. Incident macular atrophy was defined as a well-demarcated region or regions of marked hypoautofluorescence from an absence of the retinal pigment epithelium measuring at least 0.02 mm2.
In the T&E group (n = 163), macular atrophy was present in 24% (39/ 163) of eyes at baseline and 27% (34/ 124) at four years. In the PRN group (n = 101), the rates of macular atrophy were 20% (20/101) at baseline and 25% (20/81) at four years.
According to regression analysis, the risk of new macular atrophy did not differ by treatment regimen. Atrophic growth was similar in the two groups (approximately 0.4 mm2/year). In multivariate analysis, significant baseline predictors of atrophic progression were older age, poorer visual acuity (VA), and the presence of retinal angiomatous proliferation. By year 4, eyes in the T&E group had received significantly more injections (29.3 vs. 15.7) and VA was similar to baseline values, but acuity in the PRN group had declined from baseline.
These findings suggest that the T&E and PRN protocols are indistinguishable in terms of macular atrophy occurrence and expansion in patients with AMD. Although T&E involved more injections over four years, it improved functional outcomes significantly without accelerating atrophic progression. Thus, it may be preferable overall to PRN, said the authors.
The original article can be found here.