IT'S NOT THAT GOOD

Anti-VEGF effect on development of macular atrophy under study

 

A secondary analysis of data gathered in the IVAN trial looking at the question of whether anti-VEGFs cause macular atrophy yielded no definitive answer but did evoke more questions.

 “We’ve all seen patients in clinic who have had a good response in terms of fluid but have ended up with a reduction in visual acuity due to progression of macular atrophy,” Clare Bailey, MD, said at the Euretina meeting. The follow-on analysis of 596 eyes was undertaken to more precisely grade macular lesions with particular attention given to location of the atrophy and proximity to the area of the neovascular complex.

At final visit in the anti-VEGF treatment trial, 135 eyes had developed atrophy within the lesion that was not present at baseline, and 390 eyes had no atrophy either at baseline or final visit.

In the 248 eyes with lesions in the fellow eye at baseline, 25 patients developed intralesional atrophy that was not present at baseline, and 159 patients had no atrophy at baseline or final visit.

Baseline predominately classic choroidal neovascularization appeared to reduce the odds of developing geographic atrophy, Bailey said. When eyes with atrophy progression were included in the analysis, then the presence of subretinal fluid was also associated with a reduction in risk of developing atrophy.

“Not surprisingly, the presence of atrophy in the fellow eye within the lesion or outside the lesion resulted in an increased risk,” she said.

When visual function was compared between eyes with no lesion atrophy at baseline or final visit and eyes with no lesion atrophy at baseline but that developed atrophy by final visit, near visual acuity improved less in those eyes that developed atrophy and reading speed deteriorated more in those patients who developed atrophy. Best corrected visual acuity and contrast sensitivity were not associated with changes in the level of atrophy.

“Treatment regimen, number of injections or drug used were not significantly associated with the development or progression of atrophy within the lesion,” .

Whether atrophy can be disregarded as a problem needs further investigation, Bailey said, and because the presence of subretinal fluid was associated with decreased risk of progression, a new question is whether “perhaps a little bit of subretinal fluid is not really a bad thing.” 

 OFTALMÓLOGO ESTEPONA