Vision-threatening lesions developing with longer-term follow-up after treatment of neovascular age-related macular degeneration

Erika Tanaka, Voraporn Chaikitmongkol, Susan B Bressler, Neil M Bressler

Research output: Contribution to journalArticle

Abstract

Purpose: To assess the development of vision-threatening lesions at least 3.5 years after initiating antivascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) in eyes with age-related macular degeneration (AMD). Design: Retrospective cohort study. Participants: A total of 75 patients (81 eyes) with CNV secondary to AMD who received intravitreous anti-VEGF treatment and were followed for at least 3.5 years after initiating treatment. Methods: Retrospective record review of patients initiating anti-VEGF treatment between November 2005 and June 2008 at a university-based institution for whom at least 3.5 years of follow-up was available at the same institution. Main Outcome Measures: Predominantly hemorrhagic lesions or geographic atrophy (GA). Results: Among 75 patients (81 eyes; 59% were women; median age, 78 years), mean follow-up was 4.9 years and at least 6 years for 40%. Median visual acuity (VA) was 20/80 (interquartile range [IQR], 20/50e20/100) initially, 20/63 (IQR, 20/40-20/160) at 2 years, 20/80 (IQR, 20/40e20/200) at 3.5 years, and 20/63 (IQR 20/32e20/200) at 6 years. Six eyes (7%) had predominantly hemorrhagic lesions initially, whereas this developed in an additional 3 eyes (4%, 95% confidence interval [CI], 1% to 10%) in 3.5 years and in 1 additional eye (1%, 95% CI, 0.03% to 7%) at more than 3.5 years of follow-up. Initially, GA within or overlapping the boundary of the entire CNV was present in 4 eyes (5%) and outside this boundary in 8 eyes (10%). Geographic atrophy enlarged in each eye over time. The only eyes that developed GA outside the CNV boundary were those that had GA outside the lesion at baseline. Additional atrophy within the boundary of CNV defined at baseline, termed "atrophic disciform scars," developed in 5 eyes (6%), all within 4 years of treatment initiation. Conclusions: Longer-term follow-up of neovascular AMD managed with anti-VEGF therapy suggests that predominantly hemorrhagic lesions may develop within 3.5 years of initiating therapy and more than 3.5 years after initiating therapy. In contrast, new areas of GA beyond the boundaries of the CNV lesion as defined at initiation of anti-VEGF therapy seem unlikely to develop if there is no GA outside of the CNV lesion initially.

Original languageEnglish (US)
Pages (from-to)153-161
Number of pages9
JournalOphthalmology
Volume122
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Macular Degeneration
Geographic Atrophy
Choroidal Neovascularization
Vascular Endothelial Growth Factor A
Therapeutics
Endothelial Growth Factors
Confidence Intervals
Visual Acuity
Atrophy
Cicatrix
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology
  • Medicine(all)

Cite this

Vision-threatening lesions developing with longer-term follow-up after treatment of neovascular age-related macular degeneration. / Tanaka, Erika; Chaikitmongkol, Voraporn; Bressler, Susan B; Bressler, Neil M.

In: Ophthalmology, Vol. 122, No. 1, 01.01.2015, p. 153-161.

Research output: Contribution to journalArticle

@article{18b29f4c3089407f8af17c4a8565a887,
title = "Vision-threatening lesions developing with longer-term follow-up after treatment of neovascular age-related macular degeneration",
abstract = "Purpose: To assess the development of vision-threatening lesions at least 3.5 years after initiating antivascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) in eyes with age-related macular degeneration (AMD). Design: Retrospective cohort study. Participants: A total of 75 patients (81 eyes) with CNV secondary to AMD who received intravitreous anti-VEGF treatment and were followed for at least 3.5 years after initiating treatment. Methods: Retrospective record review of patients initiating anti-VEGF treatment between November 2005 and June 2008 at a university-based institution for whom at least 3.5 years of follow-up was available at the same institution. Main Outcome Measures: Predominantly hemorrhagic lesions or geographic atrophy (GA). Results: Among 75 patients (81 eyes; 59{\%} were women; median age, 78 years), mean follow-up was 4.9 years and at least 6 years for 40{\%}. Median visual acuity (VA) was 20/80 (interquartile range [IQR], 20/50e20/100) initially, 20/63 (IQR, 20/40-20/160) at 2 years, 20/80 (IQR, 20/40e20/200) at 3.5 years, and 20/63 (IQR 20/32e20/200) at 6 years. Six eyes (7{\%}) had predominantly hemorrhagic lesions initially, whereas this developed in an additional 3 eyes (4{\%}, 95{\%} confidence interval [CI], 1{\%} to 10{\%}) in 3.5 years and in 1 additional eye (1{\%}, 95{\%} CI, 0.03{\%} to 7{\%}) at more than 3.5 years of follow-up. Initially, GA within or overlapping the boundary of the entire CNV was present in 4 eyes (5{\%}) and outside this boundary in 8 eyes (10{\%}). Geographic atrophy enlarged in each eye over time. The only eyes that developed GA outside the CNV boundary were those that had GA outside the lesion at baseline. Additional atrophy within the boundary of CNV defined at baseline, termed {"}atrophic disciform scars,{"} developed in 5 eyes (6{\%}), all within 4 years of treatment initiation. Conclusions: Longer-term follow-up of neovascular AMD managed with anti-VEGF therapy suggests that predominantly hemorrhagic lesions may develop within 3.5 years of initiating therapy and more than 3.5 years after initiating therapy. In contrast, new areas of GA beyond the boundaries of the CNV lesion as defined at initiation of anti-VEGF therapy seem unlikely to develop if there is no GA outside of the CNV lesion initially.",
author = "Erika Tanaka and Voraporn Chaikitmongkol and Bressler, {Susan B} and Bressler, {Neil M}",
year = "2015",
month = "1",
day = "1",
doi = "10.1016/j.ophtha.2014.07.046",
language = "English (US)",
volume = "122",
pages = "153--161",
journal = "Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Vision-threatening lesions developing with longer-term follow-up after treatment of neovascular age-related macular degeneration

AU - Tanaka, Erika

AU - Chaikitmongkol, Voraporn

AU - Bressler, Susan B

AU - Bressler, Neil M

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Purpose: To assess the development of vision-threatening lesions at least 3.5 years after initiating antivascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) in eyes with age-related macular degeneration (AMD). Design: Retrospective cohort study. Participants: A total of 75 patients (81 eyes) with CNV secondary to AMD who received intravitreous anti-VEGF treatment and were followed for at least 3.5 years after initiating treatment. Methods: Retrospective record review of patients initiating anti-VEGF treatment between November 2005 and June 2008 at a university-based institution for whom at least 3.5 years of follow-up was available at the same institution. Main Outcome Measures: Predominantly hemorrhagic lesions or geographic atrophy (GA). Results: Among 75 patients (81 eyes; 59% were women; median age, 78 years), mean follow-up was 4.9 years and at least 6 years for 40%. Median visual acuity (VA) was 20/80 (interquartile range [IQR], 20/50e20/100) initially, 20/63 (IQR, 20/40-20/160) at 2 years, 20/80 (IQR, 20/40e20/200) at 3.5 years, and 20/63 (IQR 20/32e20/200) at 6 years. Six eyes (7%) had predominantly hemorrhagic lesions initially, whereas this developed in an additional 3 eyes (4%, 95% confidence interval [CI], 1% to 10%) in 3.5 years and in 1 additional eye (1%, 95% CI, 0.03% to 7%) at more than 3.5 years of follow-up. Initially, GA within or overlapping the boundary of the entire CNV was present in 4 eyes (5%) and outside this boundary in 8 eyes (10%). Geographic atrophy enlarged in each eye over time. The only eyes that developed GA outside the CNV boundary were those that had GA outside the lesion at baseline. Additional atrophy within the boundary of CNV defined at baseline, termed "atrophic disciform scars," developed in 5 eyes (6%), all within 4 years of treatment initiation. Conclusions: Longer-term follow-up of neovascular AMD managed with anti-VEGF therapy suggests that predominantly hemorrhagic lesions may develop within 3.5 years of initiating therapy and more than 3.5 years after initiating therapy. In contrast, new areas of GA beyond the boundaries of the CNV lesion as defined at initiation of anti-VEGF therapy seem unlikely to develop if there is no GA outside of the CNV lesion initially.

AB - Purpose: To assess the development of vision-threatening lesions at least 3.5 years after initiating antivascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) in eyes with age-related macular degeneration (AMD). Design: Retrospective cohort study. Participants: A total of 75 patients (81 eyes) with CNV secondary to AMD who received intravitreous anti-VEGF treatment and were followed for at least 3.5 years after initiating treatment. Methods: Retrospective record review of patients initiating anti-VEGF treatment between November 2005 and June 2008 at a university-based institution for whom at least 3.5 years of follow-up was available at the same institution. Main Outcome Measures: Predominantly hemorrhagic lesions or geographic atrophy (GA). Results: Among 75 patients (81 eyes; 59% were women; median age, 78 years), mean follow-up was 4.9 years and at least 6 years for 40%. Median visual acuity (VA) was 20/80 (interquartile range [IQR], 20/50e20/100) initially, 20/63 (IQR, 20/40-20/160) at 2 years, 20/80 (IQR, 20/40e20/200) at 3.5 years, and 20/63 (IQR 20/32e20/200) at 6 years. Six eyes (7%) had predominantly hemorrhagic lesions initially, whereas this developed in an additional 3 eyes (4%, 95% confidence interval [CI], 1% to 10%) in 3.5 years and in 1 additional eye (1%, 95% CI, 0.03% to 7%) at more than 3.5 years of follow-up. Initially, GA within or overlapping the boundary of the entire CNV was present in 4 eyes (5%) and outside this boundary in 8 eyes (10%). Geographic atrophy enlarged in each eye over time. The only eyes that developed GA outside the CNV boundary were those that had GA outside the lesion at baseline. Additional atrophy within the boundary of CNV defined at baseline, termed "atrophic disciform scars," developed in 5 eyes (6%), all within 4 years of treatment initiation. Conclusions: Longer-term follow-up of neovascular AMD managed with anti-VEGF therapy suggests that predominantly hemorrhagic lesions may develop within 3.5 years of initiating therapy and more than 3.5 years after initiating therapy. In contrast, new areas of GA beyond the boundaries of the CNV lesion as defined at initiation of anti-VEGF therapy seem unlikely to develop if there is no GA outside of the CNV lesion initially.

UR - http://www.scopus.com/inward/record.url?scp=84920742702&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84920742702&partnerID=8YFLogxK

U2 - 10.1016/j.ophtha.2014.07.046

DO - 10.1016/j.ophtha.2014.07.046

M3 - Article

C2 - 25283060

AN - SCOPUS:84920742702

VL - 122

SP - 153

EP - 161

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 1

ER -