ArticleRetina (Philadelphia, Pa.)2025
Incidence, Characteristics, and Outcomes of Macular Neovascularization in Extensive Macular Atrophy with Pseudodrusen-like Appearance.
Article in Retina (Philadelphia, Pa.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo report the incidence, features, and clinical outcomes of macular neovascularization (MNV) in a large Italian cohort of patients with extensive macular atrophy with pseudodrusen-like appearance (EMAP).
methodsRetrospective, longitudinal study including 79 EMAP patients (158 eyes) with ≥6 months of follow-up at three retina clinics. Medical records and imaging were reviewed for demographic and clinical data, including age, best-corrected visual acuity (BCVA), MNV features, and retinal pigment epithelium (RPE) atrophy size, measured by short-wavelength autofluorescence and refined with near-infrared and OCT imaging. Main outcomes included cumulative MNV incidence, MNV risk factors, and BCVA and RPE atrophy changes in eyes with and without MNV.
resultsOver a mean follow-up of 40.4 months, MNV developed in 14 eyes (10 patients), with a 4-year cumulative incidence of 15.2%. Most MNVs were type 2 (86%) and subfoveal (64%). Cox regression identified younger age, fellow eye involvement, smaller RPE atrophy size, and greater central subfield thickness (all p<0.01) as significant risk factors for MNV. While eyes with MNV had lower baseline BCVA (58.4 vs. 71.4 letters, approximately 20/63 vs. 20/40 Snellen; p=0.005), BCVA decline over time was similar between the two groups (-3.9 vs. -4.1 letters/year, p=0.69). However, RPE atrophy progressed faster in MNV eyes (3.4 vs. 2.8 mm 2 /year, p=0.02).
conclusionsIn this EMAP cohort, MNV had a cumulative incidence of 15.2% at 4 years. Although BCVA outcomes were comparable, MNV was associated with faster atrophy progression, potentially due to a more aggressive disease phenotype or fibro-atrophic changes.
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