Morphological changes of macular neovascularization during long-term anti-VEGF-therapy in neovascular age-related macular degeneration
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Morphological changes of macular neovascularization during long-term anti-VEGF-therapy in neovascular age-related macular degeneration. / Pauleikhoff, Daniel; Gunnemann, Marie-Luise; Ziegler, Martin; Heimes-Bussmann, Britta; Bormann, Eike; Bachmeier, Isabel; Yu, Siqing; Garcia Armendariz, Beatriz; Pauleikhoff, Laurenz.
In: PLOS ONE, Vol. 18, No. 12, 2023, p. e0288861.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Morphological changes of macular neovascularization during long-term anti-VEGF-therapy in neovascular age-related macular degeneration
AU - Pauleikhoff, Daniel
AU - Gunnemann, Marie-Luise
AU - Ziegler, Martin
AU - Heimes-Bussmann, Britta
AU - Bormann, Eike
AU - Bachmeier, Isabel
AU - Yu, Siqing
AU - Garcia Armendariz, Beatriz
AU - Pauleikhoff, Laurenz
N1 - Copyright: © 2023 Pauleikhoff et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2023
Y1 - 2023
N2 - PURPOSE: To analyze the morphological changes of macular neovascularization (MNV) in exudative neovascular age-related macular degeneration under long-term intravitreal anti-vascular endothelial growth factor (VEGF) therapy in a retrospective cohort study.METHODS AND PATIENTS: We evaluated 143 nAMD eyes of 94 patients (31 male, 63 female; initial age 55-97 y, mean age 75.9 ± 7.5 y), who started anti-VEGF therapy (IVAN pro re nata (PRN) protocol) between 2009-2018 and received ongoing therapy until the last recorded visit (mean follow-up 5.3 ± 2.9 y, range 1-14 y). The mean total number of injections was 33.3 ± 19.8 with 7.0 ± 2.3 injections/year. MNV size and, if present, associated complete retinal pigment epithelium (RPE) and outer retina atrophy (cRORA) size were measured on optical coherence tomography (OCT) volume scans at the initial visit and for each year of follow-up. MNV and cRORA were identified on B-scans and their respective borders were manually transposed onto the en-face near infrared image and measured in mm2.RESULTS: MNV enlarged through follow-up, with a mean growth rate of 1.24 mm2 / year. The mean growth in MNV size was independent of initial MNV size, age, gender, MNV subtypes or number of injections per year. Nevertheless, a great interindividual variation in size and growth was observed. cRORA developed in association with increasing MNV size and its incidence increased linearly over follow-up. cRORA lesions also showed continuous growth by a rate of 1.22 mm2 / year.CONCLUSIONS: Despite frequent long-term anti-VEGF therapy, we observed ongoing MNV growth. This is consistent with the concept that the development of MNV may be a physiological biological repair mechanism to preserve RPE and photoreceptor function, provided hyperpermeability and fluid exudation are controlled. Whether recurring low VEGF levels or other factors are responsible for MNV growth remains controversial.
AB - PURPOSE: To analyze the morphological changes of macular neovascularization (MNV) in exudative neovascular age-related macular degeneration under long-term intravitreal anti-vascular endothelial growth factor (VEGF) therapy in a retrospective cohort study.METHODS AND PATIENTS: We evaluated 143 nAMD eyes of 94 patients (31 male, 63 female; initial age 55-97 y, mean age 75.9 ± 7.5 y), who started anti-VEGF therapy (IVAN pro re nata (PRN) protocol) between 2009-2018 and received ongoing therapy until the last recorded visit (mean follow-up 5.3 ± 2.9 y, range 1-14 y). The mean total number of injections was 33.3 ± 19.8 with 7.0 ± 2.3 injections/year. MNV size and, if present, associated complete retinal pigment epithelium (RPE) and outer retina atrophy (cRORA) size were measured on optical coherence tomography (OCT) volume scans at the initial visit and for each year of follow-up. MNV and cRORA were identified on B-scans and their respective borders were manually transposed onto the en-face near infrared image and measured in mm2.RESULTS: MNV enlarged through follow-up, with a mean growth rate of 1.24 mm2 / year. The mean growth in MNV size was independent of initial MNV size, age, gender, MNV subtypes or number of injections per year. Nevertheless, a great interindividual variation in size and growth was observed. cRORA developed in association with increasing MNV size and its incidence increased linearly over follow-up. cRORA lesions also showed continuous growth by a rate of 1.22 mm2 / year.CONCLUSIONS: Despite frequent long-term anti-VEGF therapy, we observed ongoing MNV growth. This is consistent with the concept that the development of MNV may be a physiological biological repair mechanism to preserve RPE and photoreceptor function, provided hyperpermeability and fluid exudation are controlled. Whether recurring low VEGF levels or other factors are responsible for MNV growth remains controversial.
KW - Humans
KW - Male
KW - Female
KW - Aged
KW - Aged, 80 and over
KW - Middle Aged
KW - Angiogenesis Inhibitors/therapeutic use
KW - Vascular Endothelial Growth Factor A/therapeutic use
KW - Retrospective Studies
KW - Fluorescein Angiography
KW - Choroidal Neovascularization/diagnostic imaging
KW - Intravitreal Injections
KW - Macular Degeneration/diagnostic imaging
KW - Tomography, Optical Coherence
KW - Wet Macular Degeneration/drug therapy
U2 - 10.1371/journal.pone.0288861
DO - 10.1371/journal.pone.0288861
M3 - SCORING: Journal article
C2 - 38134207
VL - 18
SP - e0288861
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 12
ER -