Early prediction of macular neovascularization phenotypes and prognostic evolution

To investigate baseline predictors of macular neovascularization (MNV) phenotypes and prognostic outcomes, including changes in visual acuity (VA) and the development of macular atrophy (MA) and fibrosis.

A retrospective, observational, cohort study was performed on a total of 102 eyes from 97 patients with intermediate age-related macular degeneration (AMD) converting to MNV subtypes. Baseline features, including age, drusen, reticular pseudodrusen (RPD), subfoveal choroidal thickness (SFCT), and central retinal thickness (CRT), were analyzed. Predictive models that considered the baseline characteristics predicting the different MNV subtypes and prognostic outcomes were developed using Cox regression and generalized linear models.

Of the included eyes, 68.6% developed type 1 MNV, 15.7% type 2 MNV, and 15.7% type 3 MNV. SFCT was a significant predictor of type 2 MNV, with thicker choroid predisposing to the lesion development (HR: 1.02, CI95%: 1, 1.03, p = 0.001). Age was the primary predictor for type 3 MNV (HR: 1.1, CI 95%: 1, 1.2, p = 0.02). Type 2 MNV exhibited the highest rate of fibrosis at follow-up (71.4%), compared to both type 1 (43.5%) and type 3 MNV (26.7%) (p = 0.04). Age at baseline and best-corrected visual acuity (BCVA) were factors associated with final vision loss (p < 0.001), while the presence of drusen alone appeared protective (p = 0.03). SFCT at baseline also reduced the risk of outer retinal atrophy (p = 0.01).

SFCT served as a key indicator for type 2 MNV while aging predominantly predicted type 3 MNV. The findings may improve the early identification and tailored management of MNV phenotypes, optimizing visual outcomes and mitigating complications such as fibrosis and atrophy.