Researchers in Italy studied neovascular age-related macular degeneration (nAMD) eyes in remission to better understand the clinical significance of fibrotic scars in these patients. First, they used imaging analysis to categorize the scar appearance as either fibrocellular or fibrovascular. Next, they evaluated the eyes’ functional ability on best-corrected visual acuity and macular function, plus imaging and exam assessment of structural changes.

Eyes with fibrocellular scars had worse structural and functional impairment than those with fibrovascular lesions, and were more likely to be associated with retinal pigment epithelium damage and reduced vascular perfusion.

Best-corrected visual acuity was 0.7±0.5 LogMAR in the fibrocellular group and 0.3±0.2 LogMAR in the fibrovascular group. RPE atrophy was noted in 17 eyes with the fibrocellular phenotype compared with only eight of the fibrovascular eyes. The perfusion density within the neovascular lesion was 28.9%±9.9% in the fibrocellular group and 44.2%±5.9 % in the fibrovascular group.

Researchers suggest that neovascularization could be considered an attempt to recapitulate the impaired perfusion from the choriocapillaris. On reaching a remission state, the neovascular lesion may be important in nourishing the RPE and outer retinal layers. Conversely, neovascular regression and fibrocellular replacement may reduce that nourishment and cause atrophy and macular function reduction. The study concludes that its findings could raise discussion on the need for novel treatment approaches to induce maturation of vessels instead of seeking to eliminate them.

Querques L, Parravano M, Borrelli E, et al. Anatomical and functional changes in neovascular AMD in remission: comparison of fibrocellular and fibrovascular phenotypes. Br J Ophthalmol. April 18, 2019. [Epub ahead of print].