Arrigo Alessandro, Saladino Andrea, Aragona Emanuela, Barresi Costanza, Mularoni Cecilia, Bandello Francesco, Battaglia Parodi Maurizio
Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Ophthalmol Ther. 2024 May;13(5):1185-1196. doi: 10.1007/s40123-024-00903-4. Epub 2024 Mar 6.
Macular neovascularization (MNV) secondary to age-related macular degeneration (AMD) is well managed by anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. However, outer retinal atrophy represents an unavoidable occurrence detected during follow-up. Several imaging metrics have been proposed as clinically relevant in stratifying the risk of onset of outer retinal atrophy. The main goal of this study is to evaluate the impact of noninvasive imaging metrics on the assessment of outer retinal atrophy onset in a large cohort of eyes with neovascular AMD managed in a real-world setting.
This study was a prospective, observational, case series. We included patients affected by newly diagnosed neovascular AMD, requiring anti-VEGF intravitreal injections. We collected clinical and imaging data, with a planned follow-up of 24 months. The multimodal imaging protocol included optical coherence tomography, optical coherence tomography angiography, and fundus autofluorescence. We collected noninvasive imaging metrics and we assessed the relationship with the morphological and functional outcome evaluated at 12-month and 24-month time points.
We included 370 eyes of 370 patients with exudative AMD (210 male; mean age 79 ± 8 years). MNV were classified as follows: type 1, 198 (54%); type 2, 89 (24%); polypoidal choroidal vasculopathy, 29 (7%); and type 3, 54 (15%). A total of 120 out of 370 eyes (33%) showed complete outer retinal atrophy at the end of the 2-year follow-up. The presence of intraretinal fluid, thinning of the Sattler choroidal layer, late anti-VEGF switch, the overall number of anti-VEGF injections, and the perfusion characteristics of the MNV were found to be the most relevant factors associated with the onset of outer retinal atrophy. The other collected metrics were found to be less clinically relevant, also showing no cumulative effect in the multivariate analysis (p > 0.05).
We identified imaging metrics significantly associated with the 2-year risk onset of outer retinal atrophy. These metrics might pave the way for the development of future customized anti-VEGF treatment strategies.
年龄相关性黄斑变性（AMD）继发的黄斑新生血管（MNV）通过抗血管内皮生长因子（anti-VEGF）玻璃体腔内注射得到了很好的治疗。然而，视网膜外层萎缩是随访期间不可避免出现的情况。已经提出了几种影像学指标，在分层视网膜外层萎缩发病风险方面具有临床相关性。本研究的主要目的是评估非侵入性影像学指标对一大群在现实世界中接受治疗的新生血管性AMD患者视网膜外层萎缩发病评估的影响。
本研究是一项前瞻性、观察性病例系列研究。我们纳入了新诊断为新生血管性AMD且需要抗VEGF玻璃体腔内注射的患者。我们收集了临床和影像学数据，计划随访24个月。多模态成像方案包括光学相干断层扫描、光学相干断层扫描血管造影和眼底自发荧光。我们收集了非侵入性影像学指标，并评估了其与在12个月和24个月时间点评估的形态学和功能结果之间的关系。
我们纳入了370例渗出性AMD患者的370只眼（男性210例；平均年龄79±8岁）。MNV分类如下：1型，198只眼（54%）；2型，89只眼（24%）；息肉样脉络膜血管病变，29只眼（7%）；3型，54只眼（15%）。在2年随访结束时，370只眼中共有120只眼（33%）出现了完全性视网膜外层萎缩。发现视网膜内液的存在、萨特勒脉络膜层变薄、抗VEGF治疗的晚期转换、抗VEGF注射的总数以及MNV的灌注特征是与视网膜外层萎缩发病最相关的因素。发现其他收集的指标临床相关性较小，在多变量分析中也未显示出累积效应（p>0.05）。
我们确定了与2年视网膜外层萎缩发病风险显著相关的影像学指标。这些指标可能为未来定制抗VEGF治疗策略的发展铺平道路。
