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Clinical science
Characterisation of macular neovascularisation in geographic atrophy
  1. Riccardo Sacconi1,2,3,
  2. Maria Brambati1,2,
  3. Alexandra Miere4,
  4. Eliana Costanzo5,
  5. Vittorio Capuano4,
  6. Enrico Borrelli1,2,
  7. Marco Battista1,2,
  8. Mariacristina Parravano5,
  9. Eric H Souied4,
  10. Francesco Bandello1,2,
  11. Giuseppe Querques1,2
  1. 1 School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
  2. 2 Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
  3. 3 Clinical Research Centre, Hospital Intercommunal de Creteil, Creteil, France
  4. 4 Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
  5. 5 Foundation G.B. Bietti-IRCCS, Rome, Italy
  1. Correspondence to Giuseppe Querques, Department of Ophthalmology, Ospedale San Raffaele, Milano 20132, Italy; querques.giuseppe{at}hsr.it

Abstract

Aim To characterise macular neovascularisation (MNV) developing in eyes affected by geographic atrophy (GA).

Methods In this multicentric longitudinal study involving three retina referral centres, patients previously affected by GA who developed an active MNV were included. Patients were investigated using structural optical coherence tomography (OCT), fundus autofluorescence, OCT-angiography and dye angiographies. Patients were treated with ProReNata antivascular endothelial growth factor (VEGF) injections and were revaluated after treatment.

Results Among 512 patients previously diagnosed with GA, 40 eyes of 40 patients (mean age 80.8±7.9 years, mean GA area 8.73±7.39 mm2) presented with treatment-naïve exudative MNV (accounting for an estimated prevalence of 7.81%; 5.49 to 10.13, 95% CIs) and thus were included in the analysis. 67.5% of MNVs were classified as type 2 MNV, 25% as type 1, 2.5% as type 3 and 5% as mixed phenotype. In 92.5% of cases, active MNV in GA showed subretinal hyperreflective material with or without evidence of subretinal/intraretinal hyporeflective exudation. During a mean follow-up of 28±25 months, patients were treated with 6.6±6.3 anti-VEGF injections, with 2.9±1.4 injections in the first year of treatment. No patient developed GA enlargement in the area of MNV.

Conclusions MNVs in GA showed different features and therapeutic response in comparison to previously reported features of MNV in age-related macular degeneration (AMD) without GA. For these reasons, the combined phenotype (ie, GA with neovascular AMD) should be considered as a distinct entity in the research and clinical setting.

  • imaging
  • macula
  • neovascularisation
  • retina

Data availability statement

Data are available upon reasonable request. Please contact the corresponding author, professor GQ, email: querques.giuseppe@hsr.it.

https://doi.org/10.1136/bjophthalmol-2021-318820

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    Data availability statement

    Data are available upon reasonable request. Please contact the corresponding author, professor GQ, email: querques.giuseppe@hsr.it.

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    Footnotes

    • Contributors RS and GQ: research design, data acquisition and analysis, interpretation of data, drafting the manuscript and critical revision of the manuscript. MBr, AM, EC, VC, EB and MBa: data acquisition and analysis, critical revision of the manuscript. MP, EHS and FB: interpretation of data and critical revision of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RS is a consultant for Carl Zeiss Meditec (Dublin, USA), Novartis (Basel, Switzerland). EB is a consultant for Centervue (Padova, Italy), Carl Zeiss Meditec (Dublin, USA), Novartis (Basel, Switzerland). MP is a consultant for Allergan (Irvine, California,USA), Bayer Shering-Pharma (Berlin, Germany), Novartis (Basel, Switzerland), Zeiss (Dublin, USA). EHS is a consultant for Allergan (Irvine, California,USA), Bayer Shering-Pharma (Berlin, Germany), Novartis (Basel, Switzerland), Roche (Basel, Switzerland). FB is a consultant for Alcon (Fort Worth,Texas,USA), Alimera Sciences (Alpharetta, Georgia, USA), Allergan (Irvine, California,USA), Farmila-Thea (Clermont-Ferrand, France), Bayer Shering-Pharma (Berlin, Germany), Bausch And Lomb (Rochester, New York, USA), Genentech (San Francisco, California, USA), Hoffmann-La-Roche (Basel, Switzerland), Novagali Pharma (Évry, France), Novartis (Basel, Switzerland), Sanofi-Aventis (Paris, France), Thrombogenics (Heverlee,Belgium), Zeiss (Dublin, USA). GQ is a consultant for Alimera Sciences (Alpharetta, Georgia, USA), Allergan (Irvine, California, USA), Bayer Shering-Pharma (Berlin, Germany), Heidelberg (Germany), Novartis (Basel, Switzerland), Sandoz (Berlin, Germany), Zeiss (Dublin, USA).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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