Distinct interactions between macular neovascularization and geographic atrophy: Growth dynamics and fellow-eye risk

Purpose To compare geographic atrophy (GA) growth in eyes with and without macular neovascularization (MNV) and evaluate anti-VEGF therapy effects on GA progression. Methods One eye per patient with GA with one-year of follow-up was included. Patients who developed MNV in previously diagnosed GA were assigned to the MNV-GA group, while those who did not were assigned to the non-MNV group. OCT determined MNV location and type. GA was quantified from RPE en-face images using ImageJ over one year. Fellow eyes were followed to last visit. Analyses used SPSS with Mann–Whitney U; P < 0.05 denoted significance, and prespecified thresholds applied throughout analyses. Results A total of 60 eyes from 60 patients were included (mean age: 82.75 ± 7.31; 56.7% female). A significant difference in GA area growth over one year was observed between two groups, with slower GA enlargement in MNV-GA group (1.15 mm 2 vs. 2.36 mm 2 ; P = 0.001; and square root: 0.38 ± 0.28 vs. 0.46 ± 0.36; P = 0.040). In MNV-GA eyes, GA growth showed no correlation with the number of anti-VEGF injections ( P = 0.692). Most MNVs were type 1 (46.7%) and type 2 (43.3%) and were predominantly located at the GA border (70.0%), particularly in the central (30.0%) and superior (30.0%) sectors. Among the 60 fellow-eyes, 27 (45.0%) developed MNV during follow-up. Of these, 25 eyes (83.3%) were from patients from MNV-GA group, whereas only 2 eyes (6.7%) were from non-MNV group ( P < 0.001). Conclusion Eyes with MNV-GA showed slower GA enlargement over one-year, regardless of anti-VEGF frequency, and higher fellow-eye MNV risk, indicating shared risk factors but distinct mechanisms influencing disease progression.