PURPOSE: This article describes the clinical and multimodal imaging characteristics of subthreshold exudative choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD). METHODS: Among 3773 patients with AMD, 8 eyes (6 patients) were identified with the clinical phenotype of interest. Dilated fundus examinations, color fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and OCT angiography (OCTA) were performed. RESULTS: OCT typically showed a moderately reflective irregular pigment epithelial detachment with overlying subretinal fluid (SRF). Traditional FA did not show leakage and ICGA showed no definitive neovascular network or hot spots. However, OCTA clearly demonstrated a CNV within the pigment epithelial detachment. The majority of our cases (7 of 8) did not receive antivascular endothelial growth factor (anti-VEGF) injections, and visual acuity remained stable over the available follow-up period of I to 10 years. CONCLUSIONS: CNV is often associated with SRF and vision loss in AMD, usually requiring frequent anti-VEGF injections. OCTA allowed us to better identify CNV not readily detected on FA and ICGA. Although some have suggested early clinical intervention with anti-VEGF injections in any case with fluid and confirmed CNV on OCTA, we describe a subset of AMD patients with SRF who may be better managed by observation. These cases may represent a more indolent, mature, and stable vascular network.
PURPOSE: This article describes the clinical and multimodal imaging characteristics of subthreshold exudative choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD). METHODS: Among 3773 patients with AMD, 8 eyes (6 patients) were identified with the clinical phenotype of interest. Dilated fundus examinations, color fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and OCT angiography (OCTA) were performed. RESULTS: OCT typically showed a moderately reflective irregular pigment epithelial detachment with overlying subretinal fluid (SRF). Traditional FA did not show leakage and ICGA showed no definitive neovascular network or hot spots. However, OCTA clearly demonstrated a CNV within the pigment epithelial detachment. The majority of our cases (7 of 8) did not receive antivascular endothelial growth factor (anti-VEGF) injections, and visual acuity remained stable over the available follow-up period of I to 10 years. CONCLUSIONS: CNV is often associated with SRF and vision loss in AMD, usually requiring frequent anti-VEGF injections. OCTA allowed us to better identify CNV not readily detected on FA and ICGA. Although some have suggested early clinical intervention with anti-VEGF injections in any case with fluid and confirmed CNV on OCTA, we describe a subset of AMD patients with SRF who may be better managed by observation. These cases may represent a more indolent, mature, and stable vascular network.
Authors: Andrea Giani; Cristiano Luiselli; Daniel D Esmaili; Paola Salvetti; Mario Cigada; Joan W Miller; Giovanni Staurenghi Journal: Invest Ophthalmol Vis Sci Date: 2011-07-29 Impact factor: 4.799
Authors: Luiz Roisman; Qinqin Zhang; Ruikang K Wang; Giovanni Gregori; Anqi Zhang; Chieh-Li Chen; Mary K Durbin; Lin An; Paul F Stetson; Gillian Robbins; Andrew Miller; Fang Zheng; Philip J Rosenfeld Journal: Ophthalmology Date: 2016-02-12 Impact factor: 12.079
Authors: Irene Barbazetto; Amy Burdan; Neil M Bressler; Susan B Bressler; Laurie Haynes; Anastasios D Kapetanios; Julius Lukas; Karl Olsen; Michael Potter; Al Reaves; Philip Rosenfeld; Andrew P Schachat; H Andrew Strong; Andrea Wenkstern Journal: Arch Ophthalmol Date: 2003-09
Authors: João R de Oliveira Dias; Qinqin Zhang; José M B Garcia; Fang Zheng; Elie H Motulsky; Luiz Roisman; Andrew Miller; Chieh-Li Chen; Sophie Kubach; Luis de Sisternes; Mary K Durbin; William Feuer; Ruikang K Wang; Giovanni Gregori; Philip J Rosenfeld Journal: Ophthalmology Date: 2017-09-28 Impact factor: 12.079