# Chorioretinal Atrophy Growth After Voretigene Neparvovec Retinotopically Is Connected to Retinal Functional Rescue

## TL;DR

This study explores how chorioretinal atrophy grows after gene therapy and connects it to areas where retinal function improves.

## Contribution

The study identifies a retinotopic link between functional rescue and atrophy growth after gene therapy.

## Key findings

- Atrophy grows in areas with prior functional rescue, especially where rod function improved significantly.
- Rods with the highest sensitivity gain remain unaffected by atrophy in the first two years post-treatment.
- A metabolic imbalance between functional rod increase and threshold changes may cause atrophy.

## Abstract

Chorioretinal atrophy growth after voretigene neparvovec has been reported recently with its positive correlation with successful treatment. This finding raised the question on long-term effects and the etiology of the chorioretinal atrophy.

Using local retinal functional diagnostics, we tested whether the atrophy growth is connected to the initial local functional improvement after the therapy.

The results describe factors predicting the development of atrophy. First, the atrophy emerges after approximately 3 months in an area with local functional rescue before. The areas of the greatest gain in the number of functionally rescued rods are prone to be the initial spots of atrophy growth in almost one-half of the cases and the retinotopy corresponds with the area of a high number of post-treatment functioning rods. Second, the dark-adapted perimetry shows that the atrophy growth is in the area with functioning rescued rods. However, the rods with the greatest sensitivity gain are not the parts of the growing atrophy in the first 2 years after intervention. This preservation of rods with the greatest sensitivity seems to explain the excellent profile of rods rescue over the long term measured by full-field stimulus threshold and reported earlier.

A disbalance between the increase of functional rods and their threshold shortly after treatment could be an indicator for a metabolic origin of chorioretinal atrophy after voretigene neparvovec.

A basic understanding of the photoreceptor rescue aspects after gene therapy can demonstrate a metabolic causal influence of the efficacy on the development of side effects, such as chorioretinal atrophy.