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11-10-2018 | Ophthalmology | News | Article

Intralesional MA common in anti-VEGF treated nAMD

medwireNews: Intralesional macular atrophy (MA) is common in individuals with neovascular age-related macular degeneration (nAMD) undergoing treatment with vascular endothelial growth factor (VEGF) inhibitors, study findings indicate.

However, there is no evidence that the incidence of intralesional MA is associated with the type of VEGF inhibitor used or the treatment frequency, or that it has an impact on visual function, report Simon Harding (University of Liverpool, UK) and colleagues in Ophthalmology.

Harding and team analysed colour, fluorescein angiography and optical coherence tomography images acquired at baseline and during a 2-year follow-up period for 596 participants of the IVAN study, which compared bevacizumab with ranibizumab for the treatment of nAMD.

At baseline, 9.6% of participants had MA within the neovascular lesion in the study eye. By the end of the follow-up period, an additional 22.6% had developed intralesional MA, and 1.5% developed extralesional MA.

By contrast, incident intralesional MA developed in 25 (10.1%) of 248 fellow eyes that had a nAMD lesion at baseline.

Statistical analysis showed that the likelihood of developing intralesional MA did not differ according to the study drug and the number of treatment cycles used.

There were also no statistically significant differences between eyes with and without incident intralesional MA in best-corrected or near visual acuity, reading speed or reading index.

These findings should provide “some reassurance to clinicians,” as recent studies have “led to a debate over whether overexposure to anti-VEGF agents could cause atrophy in the macula, contributing to poor visual outcome,” Harding et al remark.

The only variables  associated with a significantly reduced likelihood of developing intralesional MA in study eyes during anti-VEGF therapy were having classic choroidal neovascularisation accounting for more than 50% of the lesion area at baseline (odds ratio [OR]=0.39), and having subretinal fluid (OR=0.41) or pigment epithelial detachment (OR=0.40) at the final visit.

In addition, the presence of intralesional MA or extralesional MA in the fellow eye at baseline were both significantly associated with an increased likelihood of incident intralesional MA in the study eye, at ORs of 2.34 and 4.96, respectively.

Harding and co-authors conclude that “it is important for clinicians to recognize that intralesional MA is common in nAMD lesions, with approximately one third of eyes treated with anti-VEGF drugs exhibiting this feature by 24 months.”

They continue: “Although the effect of intralesional MA on visual function, at least as measured by current technology, seems to be limited, the longer-term effects remain unknown.”

By Laura Cowen

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