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Case 3: nAMD in a Patient With Geographic Atrophy


Roger Goldberg, MD, presents a case of a patient showing signs of geographic atrophy who subsequently develops nAMD and highlights the favorable outcomes achieved through anti-VEGF therapy.

Arghavan Almony, MD: We’ll move to our third case. Roger, if you could.

Roger Goldberg, MD: I’m pleased to be sharing a case from my good friend and colleague Nate Steinle[, MD] down in Santa Barbara, [California]. This is a patient of his whom he refers to as one of his true VIP patients. [This is] a 71-year-old [woman] with slow-onset blurred vision in both eyes. Here’s the color fundus photo of the right eye, and we see a little bit of [geographic] atrophy present and drusen. Here’s a baseline angiogram, [and there is] no leakage present. Here’s the OCT [optical coherence tomography], where we see drusen in areas of atrophy, again, in the right eye. Here’s the left eye, [with] intermediate AMD [age-related macular degeneration]. [There is a lot] of drusen [but] no significant atrophy seen on the fundus autofluorescence [and] no leakage on the angiogram. Here we see the drusen present and maybe areas of early atrophy, but diagnosed with dry AMD with focal areas of GA [geographic atrophy]. [The] patient is [presenting with] increasing problems with their vision, is diagnosed with cataracts, and undergoes bilateral, uneventful cataract surgery. [The] patient travels to Europe and says [their] vision is great, but 4 months later, [they have] blurred vision in both eyes. Is there a PCO [posterior capsule opacification] present? Nope—no PCO found in either eye. So, what’s happened here?

Let’s take a look at the retina. Here we see leakage on the FA [fluorescein angiogram] in the right eye, and we had a good baseline from earlier. We see a small, superior macular hemorrhage in the right eye. We see that blockage present on the FA. Here’s new leakage on the FA in the left eye. I think we’ll see the OCTs momentarily here, but we see subretinal hyperreflective material [SHRM] in the right eye adjacent to the areas of [geographic] atrophy but suggestive of leakage where that hemorrhage is present. In the left eye, there’s SHRM, intraretinal fluid, and an enlarged PED.

[This is] new onset bilateral wet AMD in his VIP patient, who is a family member. He decides to treat this patient with faricimab. The patient returned in 1 month and fluid is resolved in the right eye. Here you can see the scan, and there’s total resolution of that hemorrhage, which showed up as the SHRM. Fluid is [also] resolved in the left [eye]. [There’s no] intraretinal fluid, [and] that SHRM has resolved as well. [The patient] still has the areas of atrophy. And so the patient is treated with a treat-and-extend regimen and is currently extended out to a 10-week interval on faricimab in both eyes.

Here’s how the patient looks after 6 months of treatment. Hemorrhage is resolved, still has areas of atrophy present—some just adjacent to the fovea—and still a relatively small burden of [geographic] atrophy but great control of their exudative AMD. So, I think this is a great case of a patient who’s done beautifully—a patient [who] he cares deeply about. The patient’s vision is now 20/25 in both eyes. As we have these next-generation agents…I think a lot of us felt comfortable extending patients out to a 3-month interval. We know in the pivotal studies for faricimab, patients were extended out to 4 months, so it gives you the opportunity to extend out even longer than what we had been doing in the past. This patient had a great outcome. [The] patient also has GA, [so we’re] thinking about: Are we treating this patient with one of the anticomplement agents, in addition to an anti-VEGF? In this case, the patient’s being treated with faricimab. [This is a] great case; I appreciate Dr Steinle for sharing it with us.

Transcript is AI generated and edited for clarity and readability.

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