Type 3 MNV in AMD: baseline predictors of 3-year macular atrophy development.

Purpose: To identify baseline optical coherence tomography (OCT) predictors of the 3-year macular atrophy (MA) development for type 3 macular neovascularization (MNV) secondary to neovascular age-related macular degeneration (nAMD) treated by anti-VEGF therapy.

Design: Multicenter, retrospective, longitudinal study.

Participants: We included patients with treatment-naïve type 3 MNV secondary to nAMD at baseline, treated with anti-VEGF during a 3-year follow-up.

Methods: Patients were identified from six retinal referral institutions: 1) San Raffaele University, Milan, Italy 2) University of Genova, Genova, Italy; 3) Doheny Eye Institute, Los Angeles, USA; 4) Stein Eye Institute, Los Angeles, USA; 5) University of Paris Est, Creteil, France; 6) IRCCS Bietti Foundation, Rome, Italy. Several baseline predictors of 3-year MA area were analyzed based on structural OCT and demographics.

Main outcome measures: Multivariate analysis in order to identify baseline independent predictors of the 3-year MA development for type 3 MNV secondary to nAMD treated by anti-VEGF therapy.

Results: We included 131 eyes of 131 patients (mean age 80±6-year-old, 81% females). Best-corrected visual acuity was 0.49±0.40 LogMAR at the baseline and significantly decreased to 0.59±0.43 LogMAR at the end of 3-year follow-up (p<0.001). Patients were treated with 11±6 anti-VEGF injections and developed atrophy in 75% of cases (from 18% at the baseline). Eyes that developed 3-year MA were treated with a significantly lower number of injections compared to eyes without MA (9.9±5.5 vs 14.7±7.2 injections, p<0.001). The most relevant independent predictors at baseline of MA area at 3-year follow-up were: area of MA at baseline (p<0.001), AMD phenotype (presence of reticular pseudodrusen) (p=0.017), baseline presence of nascent geographic atrophy (p=0.008), and the baseline presence of subretinal hyper-reflective material (p=0.002).

Conclusions: Macular atrophy development is a frequent complication of type 3 MNV treated with anti-VEGF injections. Several factors could be considered as baseline predictors of atrophy development during the anti-VEGF treatment.