Nascent Geographic Atrophy as a Predictor of Type 3 Macular Neovascularization Development

Riccardo Sacconi; David Sarraf; SriniVas R Sadda; K Bailey Freund; Andrea Servillo; Meira Miri Fogel Levin; Eliana Costanzo; Giulia Corradetti; Diogo Cabral; Dinah Zur; Omer Trivizki; Mariacristina Parravano; Francesco Bandello; Anat Loewenstein; Giuseppe Querques

doi:10.1016/j.oret.2023.01.019

Nascent Geographic Atrophy as a Predictor of Type 3 Macular Neovascularization Development

Ophthalmol Retina. 2023 Jul;7(7):586-592. doi: 10.1016/j.oret.2023.01.019. Epub 2023 Feb 2.

Authors

Affiliations

¹ School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
² Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States.
³ Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, University of California-Los Angeles, Los Angeles, California.
⁴ Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York.
⁵ IRCCS-Fondazione Bietti, Rome, Italy.
⁶ Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁷ School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: giuseppe.querques@hotmail.it.

PMID: 36736896
DOI: 10.1016/j.oret.2023.01.019

Abstract

Purpose: To investigate the association of nascent geographic atrophy (GA) preceding the development of exudative type 3 macular neovascularization (MNV) in patients with age-related macular degeneration (AMD).

Design: Retrospective longitudinal study.

Participants: Patients with AMD diagnosed with treatment-naive exudative type 3 MNV in 1 or both eyes were evaluated. Inclusion criteria included serial tracked structural OCT examinations for ≥ 2 years before the detection of exudative type 3 MNV.

Methods: Clinical characteristics and retinal imaging, including structural OCT at baseline and at each follow-up examination, were analyzed. Eyes showing the presence of nascent GA during the follow-up were selected for analysis of prevalence, and clinical characteristics at the site of subsequent type 3 MNV development.

Main outcome measures: Description of the prevalence and clinical characteristics of nascent GA at the site of subsequent type 3 MNV development.

Results: Overall, 97 eyes affected by type 3 MNV meeting inclusion criteria were analyzed. Of 97 eyes (71 patients), 22 eyes of 21 patients (mean age 82 ± 9 years) showed nascent GA preceding exudative type 3 MNV. The observed prevalence of nascent GA preceding exudative type 3 MNV was 22.7% (95% confidence interval, 14.4%-31.0%). Exudative type 3 MNV developed a mean of 9 ± 6 months after detection of nascent GA. The presence of reticular pseudodrusen in the study eye did not significantly influence the timing of exudative type 3 MNV development after the observation of nascent GA (P > 0.1 in all analyses). Reduced best-corrected visual acuity was recorded at the exudative type 3 stage in comparison with the nascent GA stage (P = 0.003).

Conclusions: As nascent GA may precede the development of exudative type 3 MNV, the detection of nascent GA in eyes with AMD may warrant closer surveillance to identify early exudative type 3 MNV warranting treatment.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Keywords: Age-related macular degeneration; Geographic atrophy; Nascent GA; Nascent type 3; Type 3 neovascularization.

MeSH terms

Aged
Aged, 80 and over
Choroidal Neovascularization* / diagnosis
Choroidal Neovascularization* / drug therapy
Choroidal Neovascularization* / epidemiology
Fluorescein Angiography / methods
Fundus Oculi
Geographic Atrophy* / diagnosis
Humans
Longitudinal Studies
Macular Degeneration* / diagnosis
Retrospective Studies