Exudative Progression of Treatment-Naive Nonexudative Macular Neovascularization in Age-Related Macular Degeneration: A Systematic Review With Meta-Analyses

center dot PURPOSE: To systematically review and report the rate of exudative progression over time in patients with nonex-udative macular neovascularization (MNV) in age-related macular degeneration (AMD).center dot DESIGN: Systematic review with prevalence meta-analyses and individual participant meta-analysis.center dot METHODS: We searched 10 literature databases on March 26, 2023, for studies of consecutive patients with treatment-naive nonexudative MNV in AMD. The pri-mary outcome of interest was time from diagnosis to ex-udative progression. We conducted meta-analyses on the prevalence of exudative progression at 1 and 2 years. Where possible, we extracted individual participant data from studies and conducted an individual participant meta-analysis and explored the exudative progression us-ing a time-to-event curve. center dot RESULTS: We identified 16 eligible studies with a total of 384 eyes with nonexudative MNV. Exudative progres-sion had occurred in 20.9% (95% CI 13.1%-29.8%) of eyes at 1 year and in 30.7% (95% CI 21.8%-40.4%) at 2 years. Similar results were observed in the individ-ual participant meta-analysis, showing exudative progres-sion in 18.9% (95% CI 13.5%-26.3%) of eyes at 1 year and 31.3% (95% CI 24.2%-40.0%) at 2 years. Risk fac-tors for a fast exudative progression were the presence of subretinal lipid globules, large MNV areas, rapid MNV growth, growth in pigment epithelium detachment height and width, appearance of a branching pattern, and devel-opment of a hyporeflective halo around the MNV. center dot CONCLUSIONS: Nonexudative MNVs in AMD are at high risk of exudative progression. Recognition of these lesions may allow for better individualized follow-up reg-imens in which closer monitoring may facilitate earlier diagnosis of exudative progression. (Am J Ophthalmol 2024;257: 46-56. (c) 2023 Elsevier Inc. All rights re-served.)