When retinal neovascolarisation ends in fibrosis:part 2/3 by Maria Vittoria Cicinelli

In this second of three lectures dedicated to retinal fibrosis, Professor Maria Vittoria Cicinelli from Milan shows us how not only does AMD treated with IVI very often evolve towards fibrosis (50% in 8 years) but how this is also the case for myopic membranes (34% in 5 years) and angioid striae (50% in 2 years). There are no targeted therapies, subretinal fluid fluctuations must be avoided and treatment must begin as early as possible.

Dear Friends, let us continue the course on fibrosis as, statistically, it is a natural evolution and after anti-VEGF treatment of extraordinary importance.

How to elaborate on the didactic message?I have prepared for you, to warm up the engine, 7 short boxes summarising the topical and a short introduction to the beautiful lecture by Mavi Cicinelli which you will find attached

Title:  fibrosis by numbers

(Armendariz BG, Chakravarthy U. Fibrosis in age-related neovascular macular degeneration in the anti-VEGF era, Eye 2024;38:3243-3251)

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At  Euretina24 Dr. Shruti Chandra studied the influence of the presence of fibrosis at the start of treatment of an ARMD: fibrosis was present in 14.3% of patients (2039 eyes) before starting anti-VEGF treatment (positive correlation with age):an excellent correlation with Cheong’s data (see below). As far as visual acuity recovery is concerned, it is confirmed that the presence of a pre-existing fibrosis is a negative factor.

(Chandra S.Baseline fibrosis in treatment naive nAMD: imaging features and visual outcome following loading phase of 2 mg aflibercept.FPS 2 AMD,24,EURETINA 2024,Barcelona

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Romano F, Cozzi E, Airaldi M, Nassisi M, Viola F, Aretti A, et al., Ten-Year Incidence of Fibrosis and Risk Factors for its Development in Neovascular Age-Related Macular Degeneration, Am J Ophthalmol. 2023;252:170-81

Fibrosis develops over time despite anti-VEGF-Treatment

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Cheong KX, Cheung CMG, Teo KYC. Review of Fibrosis in Neovasciular Age.-Related Macular Degeneration. Am J Ophthgalmol. 2023;246:192-222

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Anti-VEGF-TT

With the advent of anti-VEGF tt, the aim is also to reduce the percentage of nARMDs that evolve towards fibrosis: large scars have become rare but fibrosis still exists

“Fibrosis still develops despite adequate treatment with anti-VEGF”

Great! We’ve talked enough—it’s time to move on to the lecture by Dr. Maria Vittoria Cicinelli. She will show us how retinal fibrosis is a common final stage of various types of macular neovascularization, including AMD, myopia, pachychoroidal diseases, angioid streaks, and inflammation.

Mavi highlights the importance of understanding the epithelial-mesenchymal transition and the angiofibrotic switch.

As mentioned, fibrosis affects 50% of eyes with MNV due to AMD after eight years of IVI treatment—a staggering number! It also occurs in 34% of eyes treated for myopic neovascular membranes after five years and in 50% of eyes with angioid streaks in just two years. These figures alone justify our keen interest in the topic.

But no more spoilers—let’s dive into the lecture

Happy reading!

Pippo Simona