title: Type 1 neovascularization may confer resistance to geographic atrophy amongst eyes treated for neovascular age-related macular degeneration.
abstract: BACKGROUND
  To report a series of age-related macular degeneration (AMD) patients in whom progression to geographic atrophy (GA) in one eye receiving frequent intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) therapy for type 1 neovascularization (NV) was slower than that of the fellow eye with non-neovascular AMD.
  
  
  METHODS
  Retrospective, observational case series examining the clinical course and GA progression rate in four consecutive patients in which one eye harbored type 1 neovascular AMD and was receiving anti-VEGF therapy, while the fellow eye manifested signs of non-neovascular AMD only. Eligibility criteria included anti-VEGF therapy duration of over 4 years and over 50 injections. Lesion evolution was documented via multimodal imaging. GA at baseline and final visits was quantified and GA progression rate for each eye was determined.
  
  
  RESULTS
  Four consecutive patients were followed for a mean interval of 94 months (range 62-120). One eye harbored type 1 NV while the fellow eye remained non-neovascular. The former received a mean of 65.5 ± 15.2 anti-VEGF injections. Mean rate of GA progression in non-neovascular eyes was 0.076 ± 0.024 mm2/month and in type 1 NV eyes was 0.004 ± 0.005 mm2/month. Difference in GA progression rate between type 1 and non-neovascular eyes was found to be statistically significant (P = 0.001).
  
  
  CONCLUSIONS
  These findings support previous hypotheses that, unlike type 2 and 3 lesions, type 1 NV may represent a neovascular AMD subtype more resilient to GA formation. This may have implications for anti-VEGF regimens in the management of type 1 NV.
authors.affiliation: Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022 USA ; grid.413748.d000000009647995XThe LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, NY USA ; grid.21729.3f0000000419368729Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, College of Physicians and Surgeons, New York, NY USA.
authors.forename: Elona
authors.initials: E
authors.lastname: Dhrami-Gavazi
authors.affiliation: Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022 USA ; grid.413748.d000000009647995XThe LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, NY USA.
authors.forename: Chandrakumar
authors.initials: C
authors.lastname: Balaratnasingam
authors.affiliation: grid.21729.3f0000000419368729Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, College of Physicians and Surgeons, New York, NY USA.
authors.forename: Winston
authors.initials: W
authors.lastname: Lee
authors.affiliation: Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022 USA ; grid.413748.d000000009647995XThe LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, NY USA ; grid.21729.3f0000000419368729Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, College of Physicians and Surgeons, New York, NY USA ; grid.137628.90000000121698901Department of Ophthalmology, New York University School of Medicine, New York, NY USA.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
keywords: Age-related macular degeneration; Anti-vascular endothelial growth factor; Geographic atrophy; Type 1 neovascularization