Pachychoroid neovasculopathy with normal subfoveal choroidal thickness

2021 ◽  
pp. 336-338
Author(s):  
E.K. Pedanova ◽  
Keyword(s):  
Choroidal Thickness ◽  
Antiangiogenic Therapy ◽  
Structural Features ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Treatment Naïve ◽  
Detailed Assessment ◽  
Pachychoroid Neovasculopathy ◽  
The Difference

Pachychoriod neovasculopathy and typical neovascular age-related macular degeneration often look similar, but some differences have been described both genotypically and in the level of cytokine profile, which explains the difference in response to antiangiogenic therapy. It is known that pachychoriod diseases are characterized by choroidal subfoveolar thickening. However, there is currently no data on the structural features of the choroid in the presence of pachychoriod neovasculopathy outside the fovea. Purpose. To perform a detailed analysis of choroial structure on OCT scans of patients with neovascular AMD with normal choroidal subfoveolar thickness and to reveal the frequency of pachychoriodal neovasculopathy identification. Material and methods. In retrospective study, the data of 30 treatment-naive patients (30 eyes) aged 71.5±7.6 years with CNV type 1 were analyzed, including 18 women and 12 men, with a subfeolar thickness of the choroidal membrane not exceeding 250 µm. The patients underwent OCT and OCT-angiography using a Spectralis device (Heidelberg Engineering, Germany). In the foveolar zone and under the neovascular complex, if it is located outside the fovea, the structure of the choroid was analyzed: the choroidal thickness, Haller layer and choriocapillaries / layer of Sattler vessels were measured. Results. The average thickness of the choroid in the fovea in all patients was 170.1±40 µm. The thickness of Haller vessels layer was on average 112.3±20 μm, and the layer of choriocapillaries / Sattler vessels was 57.8±12 μm. In 22 eyes, the structure of the choroid and the ratio of all layers were similar in all analyzed OCT scans. However, in 8 eyes, under the CNV located extrafoveally, a thickening of the choroid was revealed up to 210.5±51 µm, the main volume of the choroid was presented by pachyvessels – dilated and enlarged vessels of the Haller layer which thickness was 189.4 ± 48 µm, and thinning of the choriocapillary / Sattler layer to 21.1±16 µm. Conclusion. Among 30 patients with normal subfoveolar thickness of the choroid, the frequency of PNV was 26.6%. Taking into account the literature data on different responses to antiangiogenic therapy in patients with PNV and typical AMD, we can once again emphasize the importance of a detailed assessment of changes in the choroid not only in the foveolar zone, but also specifically in the area of the neovascular complex. Key words: pachychoriod neovasculopathy, choroid, OCT.

scholarly journals Comparative Analysis of the Clinical Features and Long-Term Outcomes of Pachychoroid Neovasculopathy and Type 1 Neovascular Age-Related Macular Degeneration

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jong In You ◽  
Kiyoung Kim
Keyword(s):  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Long Term Outcomes ◽  
Age Related ◽  
Treatment Naïve ◽  
History Of ◽  
Pachychoroid Neovasculopathy

Purpose. To evaluate the clinical characteristics and long-term prognosis of pachychoroid neovasculopathy (PCN) when compared with type 1 neovascular age-related macular degeneration (nAMD). Methods. We retrospectively analyzed 30 and 60 patients whose eyes were diagnosed as treatment-naïve PCN or type 1 nAMD, respectively. All subjects were followed up for 5 years. Baseline angiographic characteristics and long-term clinical outcomes were compared between the two groups. Results. PCN group consisted of patients of younger age and represented more choroidal vascular hyperpermeability, polypoidal lesion, and history of central serous chorioretinopathy (CSC) at the time of diagnosis (all p  < 0.01). During the 5-year follow-up period, individuals in the PCN group received significantly fewer injections and reported better visual acuity compared to individuals in the type 1 nAMD group. A progressive decrease in the subfoveal choroidal thickness was observed in the type 1 nAMD group, while the thick choroid was maintained in the PCN group during the 5-year follow-up period. Conclusions. PCN developed in younger patients with a higher propensity of forming polypoidal lesions and a history of CSC. Long-term outcomes revealed that PCN had a thicker choroid and better visual prognosis with fewer number of intravitreal injection than that of type 1 nAMD.

A comparative study of type 1 neovascularization: Neovascular age-related macular degeneration versus pachychoroid neovasculopathy

2021 ◽  
pp. 112067212110378
Author(s):  
Muhammed Altinisik ◽  
Emin Kurt ◽  
Pinar Sonmezer ◽  
Ozcan Kayikcioglu ◽  
Suleyman Sami Ilker
Keyword(s):  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Intraretinal Fluid ◽  
Capillary Plexus ◽  
Treatment Naïve ◽  
Pachychoroid Neovasculopathy ◽  
Superficial Capillary Plexus ◽  
Morphological Patterns

Purpose: This study aimed to compare type 1 choroidal neovascularization (CNV) characteristics in eyes with pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) using optical coherence tomography angiography (OCTA). Methods: Treatment naive 23 eyes of 23 patients with PNV and 24 eyes of 24 patients with nAMD were evaluated. The height of pigment epithelial detachment (PED) and the central macular thickness were determined. OCTA sensitivity, CNV area, morphological patterns, and retinal superficial capillary plexus vessel density (SCP-VD) values were compared. The frequency of quiescent CNV, subretinal hyperreflective exudation (SHE), subretinal/intraretinal fluid, serous PED, double-layer sign (DLS), and pachyvessels were noted. Results: CNV was detected on OCTA in 83.3% of nAMD eyes and 91.3% of PNV eyes ( p = 0.66). Indistinct pattern was more common (74% vs 50%) and the CNV area (mm2) was smaller in PNV (0.77 ± 0.54 vs 1.57 ± 1.43) but did not reach significant levels ( p = 0.27 and 0.33 respectively). SCP-VD was similar between the groups ( p = 0.38). Statistically significant differences were found between groups in age and subfoveal choroidal thickness ( p < 0.05). DLS and pachyvessels were found to be more frequently in PNV ( p < 0.05). However, both groups had similar rates of quiescent CNV, SHE, subretinal/intraretinal fluid, and serous PED ( p > 0.05). Conclusion: Morphological features, area, and activation findings of type 1 CNV may play a limited role in differentiating nAMD and PNV cases.

scholarly journals Clustering of eyes with age-related macular degeneration or pachychoroid spectrum diseases based on choroidal thickness profile

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Young Ho Kim ◽  
Boram Lee ◽  
Edward Kang ◽  
Jaeryung Oh
Keyword(s):  
Macular Degeneration ◽  
Choroidal Thickness ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Soft Drusen ◽  
Pachychoroid Neovasculopathy ◽  
The Common ◽  
Common Pathogenesis ◽  
Clustering Pattern ◽  
Normal Controls

AbstractChoroidal changes have been suggested to be involved in the pathophysiology of both age-related macular degeneration (AMD) and pachychoroid spectrum diseases (PSD). To find out the choroidal characteristics of each disease groups, various groups of AMD and PSD were classified into several clusters according to choroidal profiles based on subfoveal choroidal thickness (CT), peripapillary CT, the ratio of subfoveal CT to peripapillary CT and age. We retrospectively analyzed 661 eyes, including 190 normal controls and 471 with AMD or PSDs. In the AMD groups, eyes with soft drusen or reticular pseudodrusen were belonged to the same cluster as those with classic exudative AMD (all p < 0.001). However, eyes with pachydrusen were not clustered with eyes from other AMD groups; instead, they were classified in the same cluster as eyes from the PSD group (all p < 0.001). In the PSD group, eyes with pachychoroid neovasculopathy were grouped in the same cluster of those with polypoidal choroidal vasculopathy (p < 0.001). The cluster analysis based on the CT profiles, including subfoveal CT, peripapillary CT, and their ratio, revealed a clustering pattern of eyes with AMD and PSDs. These findings support the suggestion that pachydrusen has the common pathogenesis as PSD.

Characterisation of macular neovascularisation in geographic atrophy

2021 ◽  
pp. bjophthalmol-2021-318820
Author(s):  
Riccardo Sacconi ◽  
Maria Brambati ◽  
Alexandra Miere ◽  
Eliana Costanzo ◽  
Vittorio Capuano ◽  
...  
Keyword(s):  
Fundus Autofluorescence ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
First Year ◽  
Age Related ◽  
Treatment Naïve ◽  
Type 3 ◽  
Endothelial Growth Factor

AimTo characterise macular neovascularisation (MNV) developing in eyes affected by geographic atrophy (GA).MethodsIn this multicentric longitudinal study involving three retina referral centres, patients previously affected by GA who developed an active MNV were included. Patients were investigated using structural optical coherence tomography (OCT), fundus autofluorescence, OCT-angiography and dye angiographies. Patients were treated with ProReNata antivascular endothelial growth factor (VEGF) injections and were revaluated after treatment.ResultsAmong 512 patients previously diagnosed with GA, 40 eyes of 40 patients (mean age 80.8±7.9 years, mean GA area 8.73±7.39 mm2) presented with treatment-naïve exudative MNV (accounting for an estimated prevalence of 7.81%; 5.49 to 10.13, 95% CIs) and thus were included in the analysis. 67.5% of MNVs were classified as type 2 MNV, 25% as type 1, 2.5% as type 3 and 5% as mixed phenotype. In 92.5% of cases, active MNV in GA showed subretinal hyperreflective material with or without evidence of subretinal/intraretinal hyporeflective exudation. During a mean follow-up of 28±25 months, patients were treated with 6.6±6.3 anti-VEGF injections, with 2.9±1.4 injections in the first year of treatment. No patient developed GA enlargement in the area of MNV.ConclusionsMNVs in GA showed different features and therapeutic response in comparison to previously reported features of MNV in age-related macular degeneration (AMD) without GA. For these reasons, the combined phenotype (ie, GA with neovascular AMD) should be considered as a distinct entity in the research and clinical setting.

Pachychoroid Neovasculopathy; Findings, Diagnosis, and Treatment

2020 ◽  
pp. 112-117
Keyword(s):  
Optical Coherence Tomography ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Current Treatment ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Age Related ◽  
Pachychoroid Neovasculopathy ◽  
Sign Type

Pachychoroid neovasculopathy (PNV) is a novel clinical entity with typical pachychoroid features accompanied by type 1 choroidal neovascularization (CNV). Typical optical coherence tomography finding of the disease is flat irregular pigment epithelial detachments (double layer sign). Type 1 CNV between retinal pigment epithelium and Bruch membrane is seen as a tangled network on optical coherence tomography angiography. Differential diagnosis of PNV from neovascular age-related macular degeneration is especially important because of the different epidemiological, genetic, and therapeutic features of these diseases. Current treatment approaches include intravitreal anti-vascular endothelial growth factor injections and photodynamic therapy.

scholarly journals Short-term outcomes of intravitreal brolucizumab for treatment-naïve neovascular age-related macular degeneration with type 1 choroidal neovascularization including polypoidal choroidal vasculopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hidetaka Matsumoto ◽  
Junki Hoshino ◽  
Ryo Mukai ◽  
Kosuke Nakamura ◽  
Hideo Akiyama
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Age Related Macular Degeneration ◽  
Complete Regression ◽  
Short Term ◽  
Age Related ◽  
Treatment Naïve ◽  
Subtenon Injection

AbstractWe evaluated the efficacy and safety of loading phase treatment with intravitreal brolucizumab for neovascular age-related macular degeneration (nAMD) with type 1 choroidal neovascularization (CNV). We analyzed consecutive 42 eyes of 40 patients with treatment-naïve nAMD associated with type 1 CNV. Three monthly injections of brolucizumab were completed in 36 eyes (85.7%). In those cases, best-corrected visual acuity (BCVA) was 0.24 ± 0.27 at baseline and improved significantly to 0.12 ± 0.23 after 3 months (P < 0.001). Central macular thickness was 301 ± 110 µm at baseline and decreased significantly to 160 ± 49 µm after 3 months (P < 0.001). Dry macula was achieved in 34 eyes (94.4%) after the loading phase. Central choroidal thickness was 264 ± 89 µm at baseline and decreased significantly to 223 ± 81 µm after 3 months (P < 0.001). Indocyanine green angiography after the loading phase revealed complete regression of polypoidal lesions in 15 of the 19 eyes (78.9%) with polypoidal lesions. Non-infectious intraocular inflammation (IOI) was observed in 8 of 42 eyes (19.0%) during the loading phase, while showing amelioration in response to combination therapy with topical and subtenon injection of steroids. In these eyes, BCVA after 3 months had not deteriorated as compared to that at baseline. These results indicate that loading phase treatment with intravitreal brolucizumab might be effective for improving visual acuity and reducing exudative changes in eyes with nAMD associated with type 1 CNV. Moreover, polypoidal lesions appear to frequently regress after this treatment. However, we must monitor patients carefully for brolucizumab-related IOI, and administer steroid therapy promptly.

scholarly journals Predictors of functional outcome of antiangiogenic therapy in neovascular age-related macular degeneration

2020 ◽  
Vol 13 (4) ◽  
pp. 7-13
Author(s):  
Alexandr S. Kharakozov ◽  
Alexey N. Kulikov ◽  
Dmitrii S. Maltsev
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Functional Outcome ◽  
Disease Duration ◽  
Antiangiogenic Therapy ◽  
Age Related Macular Degeneration ◽  
Ellipsoid Zone ◽  
Age Related ◽  
Treatment Naïve

Aim.To study predictive factors for functional outcome of aflibercept intravitreal antiangiogenic therapy in patients with neovascular age-related macular degeneration (nAMD). Material and methods.Thirty-six treatment naive nAMD patients (45 eyes, 26 females and 10 males, with a mean age of 74.4 10.9 years) were included in this study. All patients received 3 monthly aflibercept injections followed by 4 bimonthly aflibercept injections. Demographic characteristics, baseline best corrected visual acuity (BCVA), central retinal thickness (CRT), and structural retinal changes on optical coherence tomography (OCT) scans were evaluated for the correlation with BCVA after 10 months follow-up. Results.At the end of the follow-up period, the mean BCVA increased statistically significantly from 31 15 (~0.32) letters at baseline to 37 14 (~0.4) letters (p= 0.003). CRT at baseline and at the end of follow-up was 357 110 and 269 70 m (p 0.001), respectively. Final BCVA correlated statistically significantly with baseline BCVA (r= 0.62,p 0.0001), baseline CRT (r= 0.48,p= 0.001), and disease duration from the appearance of complaints until the therapy start (r= 0.32,p= 0.03). Structural macular changes on the OCT scans were not related to final BCVA (p 0.05) apart from the status of the ellipsoid zone (p 0.001). Final BCVA was statistically significantly lower in males than in females (34.7 14.0 (~0.4) and 45.0 9.2 (~0.63) letters, respectively,p= 0.03). Conclusion.Baseline visual acuity, gender, CRT, disease duration from the appearance of complaints until the therapy start, and status of the ellipsoid zone are predictive for the functional outcome in wet AMD patients.

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