Choroidal Neovascularization Enlargement Might Guide Treatment in Some AMD Eyes

Choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) enlarged significantly during a 6-month-or-more treatment-free period in eyes in which recurrent exudative changes developed within another 6-month follow-up period, according to a study published in Retina. However, researchers note that in eyes without recurrent exudative changes, significant enlargement of CNV did not occur.

“Moreover, the percentages of branching with tiny vessels and peripheral arcade at the CNV termini were much higher in eyes with recurrence than in eyes without recurrence,” according to researchers. “These findings may indicate CNV reactivity and predict the recurrence of exudative changes after a cessation-of-activity phase in eyes with a long-term history of anti- vascular endothelial growth factor (VEGF) therapy.”

Researchers retrospectively examined ways to predict recurrent exudation in CNV secondary to AMD using optical coherence tomography angiography (OCT-A) images of 41 eyes of 41 patients who were not currently receiving anti-VEGF treatment. For study inclusion, patients had received anti-VEGF treatment for more than 3 years for neovascular AMD at study baseline and had a treatment-free period exceeding 6 months on an as-needed regime with follow-up of another 6 months possible.

In 19 eyes with recurrence during the second 6-month follow-up, researchers found the square root of CNV area enlarged significantly (P =.036) from approximately 2.31 mm to 2.86 mm. That happened in the treatment-free time. But that did not occur in 22 eyes without recurrence, they reported. In the recurrence group, the branching with tiny vessels (42%) and peripheral arcades at the CNV termini (42%) were significantly higher when compared with the group without active CNV, at 14% and 5%, respectively, the study shows.

These results could indicate that CNV enlargement and features could possibly guide treatment timing in those eyes with exudative-free periods, according to the researchers.

Study limitations include its retrospective nature, the small number of patients studied, and the new OCT-A technology used. “Artifacts present in OCT-A images are still an important issue in OCT-A technology, as mentioned previously,” noted the investigators. “In the current study, we manually measured the CNV size because of the absence of commercially available software. Although good reproducibility of the measurement was confirmed, an automated measurement system is required in clinic settings.” 

Reference

Hikichi T, Agarie M, Kubo N, Yamauchi M. Predictors of recurrent exudation in choroidal neovascularization in age-related macular degeneration during a treatment-free period. Retina. 2020;40(11):2158–2165. doi: 10.1097/IAE.0000000000002745