Type 3 Macular Neovascularization in Age-related Macular Degeneration: Baseline Predictors of 3-Year Macular Atrophy Development

Purpose: To identify baseline OCT predictors of the 3-year macular atrophy (MA) development for type 3 (T3) macular neovascularization (MNV) secondary to neovascular age-related macular degeneration (nAMD) treated by anti-VEGF therapy. Design: Multicenter, retrospective, longitudinal study. Participants: We included patients with treatment-naive T3 MNV secondary to nAMD at baseline, treated with anti-VEGF during a 3-year follow-up. Methods: Patients were identified from 6 retinal referral institutions: (1) San Raffaele University, Milan, Italy; (2) University of Genova, Genova, Italy; (3) Doheny Eye Institute, Los Angeles; (4) Stein Eye Institute, Los Angeles; (5) University of Paris Est, Creteil, France; and (6) Istituto di Ricovero e Cura a Carattere Scientifico Bietti Foundation, Rome, Italy. Several baseline predictors of 3-year MA area were analyzed based on structural OCT and demographics. Main Outcome Measures: Multivariate analysis to identify baseline independent predictors of the 3-year MA development for T3 MNV secondary to nAMD treated by anti-VEGF therapy. Results: We included 131 eyes of 131 patients (mean age, 80 ± 6 years; 81% females). Best-corrected visual acuity was 0.49 ± 0.40 logarithm of the minimum angle of resolution (logMAR) at the baseline and significantly decreased to 0.59 ± 0.43 logMAR at the end of 3-year follow-up (P < 0.001). Patients were treated with 11 ± 6 anti-VEGF injections and developed atrophy in 75% of cases (from 18% at the baseline). Eyes that developed 3-year MA were treated with a significantly lower number of injections compared with eyes without MA (9.9 ± 5.5 vs. 14.7 ± 7.2 injections, P < 0.001). The most relevant independent predictors at baseline of MA area at 3-year follow-up were: area of MA at baseline (P < 0.001), age-related macular degeneration phenotype (presence of reticular pseudodrusen) (P = 0.017), baseline presence of nascent geographic atrophy (P = 0.008), and the baseline presence of subretinal hyperreflective material (P = 0.002). Conclusions: Macular atrophy development is a frequent complication of T3 MNV treated with anti-VEGF injections. Several factors could be considered baseline predictors of atrophy development during the anti-VEGF treatment. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.