Ciliary Neurotrophic Factor Implant in Geographic Atrophy from Age-related Macular Degeneration: A Long-Term Case Study.

Abstract

Purpose: To report a case of thirteen-year long progression of geographic atrophy (GA) from dry age-related macular degeneration (AMD) with ciliary neurotrophic factor (CNTF) implant, NT-501, in one eye, compared to the untreated contralateral eye.

Methods: Using sequential images from 2012 to 2024, the macular GA and peripapillary atrophy was identified as areas of definitely decreased autofluorescence on fundus autofluorescence (FAF) and clearly delineated areas of hyperreflectivity on near infrared reflectance (NIR-R). Optical coherence tomography B scans confirmed areas of complete retinal pigment epithelium and outer retinal atrophy to support FAF grading.

Results: A 76-year-old male received the CNTF implant in the right eye in August 2011. Macular GA area on short wavelength FAF exhibited growth from 4.51 mm2 (8/2012) to 14.46 mm2 (6/2020), in the treated right eye, and from 3.2 mm2 to 14.92 mm2 in the untreated left eye. The linearized growth rates were 0.21 mm/y (right) and 0.26 mm/y (left), showing a 16.3% difference. A similar pattern was seen on green laser FAF from 2018 to 2024, with peripapillary atrophy progression rates of 0.2 mm2/y (right) and 1.03 mm2/y (left).

Conclusions: Notably, the implanted eye, exhibited less progression of macular GA and peripapillary atrophy. While acknowledging the limitations of a single case, we highlight the potential benefits of using the CNTF implant, a one-time surgical procedure, in reducing the treatment burden for atrophic AMD patients. We hope to see further reports from other sites that participated in this compassionate use protocol for NT-501 in atrophic AMD.