Authors: Nathalie Massamba, Gisele Soubrane, Emmanuelle Champion, Nathalie Butel, Violaine Caillaux ,Bahram Bodaghi.
Purpose: The aim of this study was to evaluate intra individual the size of atrophy in both eyes and compare progression with the fellow eye which developed a CNV.
Design: Retrospective case series
Material and Methods: This study is a retrospective consecutive case series of 110 eyes undergoing exudative and non-exudative AMD. Overall two groups were identified. The first group included 55 eyes that presented with Geographic atrophy (GA) and Choroidal Neovascularization (CNV) during the follow-up. The second group consisted of the fellow eye of the same patient which presented with GA only. The study was conducted between January 2016 to June 2017at Department of Ophthalmology, PITIE SALPETRIERE University Hospital.
Group A. EYE with GA
Group B. Eye with GA associated with CNV and received Anti VEGF therapy.
In Group B, was divided into two group
B1: patients who received Ranibizumab
B2: patients who received AflIbercept
GA areas were quantified based on fundus auto fluorescence images using manually image-processing and progression. The hyper auto florescence border was also analyzing.
Results: GA was observed in 55/100 patients, 18 eyes of 9 patients were excluded. Overall we analyzed 92 eyes of 46 patients. 46 eyes of 46 patients had GA, the fellow eyes of 46 eyes remained with atrophy associated with GA at baseline, and which developed CNV during the follow -up, treated by anti-VEGF treatment. Mean follow-up after initiation of anti-VEGF therapy was 12.8 months. Mean age 76 year- old for 26 females and 20 males (SD=0.06).
Mean VA at baseline was 0.6 Log Mar vs 0.6 Log Mar at the end of the study. Central Macular thickness was 350.50 um at baseline which was reduced to 260 um at M12 (SD =91). The mean size of atrophy for both Anti VEGF group was 5.2 mm2 at baseline,7.4 mm2 at M6 and 8.7 mm2 at the end of the study specially from 5.4 mm2 at baseline to 7.1 mm2 at the end of the study for Ranibizumab group and 5.2 mm2 to 8.2 mm2 in Afflibercerpt group. Overall, the size of atrophy increased from 5.2 mm2 to 8.79 mm2 for the group atrophy with CNV vs 3.28 mm2 to 6.88 mm2 of Ophthalmol Res, 2018 Volume 1 | Issue 2 | 2 of 9 eyes with GA (FIG 1). Moreover, for groups with anti-VEGF therapy, the size of geography atrophy in Ranibizumab group increased from 5.4 mm2 to 7.1 mm2 (p = 0.4) (FIG 2), while eyes treated with Aflibercept increased from 5.2 mm2 to 8.2 mm2 after 12 months (p = 0.04) (Figure 3).
Conclusion: Previously publications have confirmed the evolution or presence of atrophy in patients treated by Anti VEGF. This cases series has confirmed these findings. Furthermore, to our knowledge, there is currently no intra-individual study comparing atrophy, because this situation is very infrequent. Our results showed that atrophy evolves in a progressively comparatively with which found in patients treated with Anti VEGF especially Aflibercept. We believed that a multicenter study with genetic analysis could still shed light on this subject.
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