Choriocapillaris flow impairment could predict the enlargement of geographic atrophy lesion

Aim To analyse the choriocapillaris (CC) flow status in the area that subsequently showed geographic atrophy (GA) expansion secondary to age-related macular degeneration (AMD) during 1-year follow-up, matching optical coherence tomography angiography (OCT-A) and fundus autofluorescence (FAF). Methods In this prospective longitudinal observational study, 30 eyes of 20 consecutive patients with GA secondary to AMD (mean age 75.5 +/- 7.4 years) were included. All patients underwent OCT-A and FAF at baseline and 1-year follow-up. Main outcome measures included analysis of perfusion density (PD) in the 'area surrounding GA margin' (between the GA border and 500 mu m distance) in comparison with the 'control area' (area outside the 500 mu m line), and of the 'expansion area' (area that subsequently developed GA expansion during 1-year follow-up). Results During the 1-year follow-up, visual acuity significantly decreased from 0.34 +/- 0.38 Logarithm of the Minimum Angle of Resolution (LogMAR) to 0.39 +/- 0.40 LogMAR (p<0.001), and mean GA area increased from 6.82 +/- 5.47 mm(2) to 8.76 +/- 6.28 mm(2) (p<0.001). CC PD of the area surrounding the GA margin revealed a significant flow impairment compared with control area (PD 0.679 +/- 0.076 and 0.734 +/- 0.057, respectively (p<0.001)). Furthermore, the PD of the expansion area showed a greater CC flow impairment in comparison to the remaining area surrounding GA margin (p<0.001). Conclusions We reported a greater CC impairment in the area that subsequently developed GA expansion, suggesting that the CC flow impairment could predict the enlargement of GA lesion. The CC impairment could be considered as a new a risk factor for GA progression and a biomarker to be measured to determine efficacy of new interventions aiming to slow progression of GA.

Automated summary

The study analyzed the choriocapillaris flow status in the area of geographic atrophy expansion secondary to age-related macular degeneration, suggesting that choriocapillaris impairment could predict the enlargement of geographic atrophy lesions.