Geographic atrophy and activity of neovascularization in retinal angiomatous proliferation

Purpose: To investigate the association between geographic atrophy (GA) and neovascular activity in retinal angiomatous proliferation (RAP) during anti-VEGF treatment. Methods: Ninety-one RAP eyes (74 patients) treated with anti-VEGF on an as-needed basis for at least 3 years were evaluated. Development of GA, area of GA, and injection numbers were assessed. Results: Eighteen eyes that developed fibrous scar or massive hemorrhage were excluded. Forty-four eyes (60%) developed GA (GA group), and 29 eyes (40%) did not develop GA (non-GA group) at year 3. The mean injection number continuously decreased in the GA group (5.1, 3.1, and 1.9 at years 1, 2, and 3, respectively, P < 0.01, < 0.01), but did not decrease at year 3 in the non-GA group (4.6, 3.5, and 3.3 at years 1, 2, and 3, respectively, P < 0.01, = 0.64). In both groups, best-corrected visual acuity improved significantly at year 1 and declined to baseline level at year 3. During the entire follow-up (mean of 48.5 months), 57 eyes developed GA. In those eyes, number of injections per year before and after the development of GA was 4.5 and 2.1 (P < 0.01), and showed continuous decline after GA development as the area of GA progressed at a rate of 1.85 mm² per year. Conclusions: The activity of RAP lesion requiring anti-VEGF treatment diminished as GA developed and progressed. Identification of GA and its progression provides further information to tailor anti-VEGF treatment for each patient.