Background To identify predictive factors for exudation for quiescent choroidal neovessels (qCNV) in the fellow eyes of eyes treated for a neovascular age-related macular degeneration (AMD). Methods Prospective observational study. One hundred and forty-four contralateral eyes of 144 patients treated for wet AMD were analysed. At a baseline visit, multimodal imaging including dye angiographies and optical coherence tomography angiography (OCT-A) was performed in order to detect qCNV. Patients were followed up for 12 months with a monthly assessment. The manifestation of any type of exudation (either intra-or subretinal fluid or hyperreflective subretinal material) was monitored. ResultsThe prevalence of qCNV in the treatment-naive eyes was 15.9% with an incidence over a 12-month period of 2.8%. In total, 40.7% of the overall neovessels remained stable with no sign of exudation, while 59.3% presented some fluid during the follow-up. A statistically significant relationship was established for the following variables preceding the exudation: increase in central macular thickness (OR = 116; 95% CI [4.74; 50530] p = 0.038), increase in pigment epithelial detachment height (OR = 1.76; 95% CI [1.17; 3.18] p = 0.021) and width (OR = 1.53; 95% CI [1.12; 2.62] p = 0.042), increase in neovessels' surface on OCT-A (OR = 6.32; 95% CI [1.62; 51.0] p = 0.033), emergence of a branching pattern (OR = 7.50; 95% CI[1.37; 61.5] p = 0.032) and appearance of a hypointense halo surrounding the lesion (OR = 10.00; 95% CI [1.41; 206] p = 0.048). Conclusions The risk of exudation in the treatment-naive fellow eyes of eyes treated for neovascular AMD was notably increased in the presence of qCNV. The biomarkers identified will help to detect their activation in order to ensure prompt antiangiogenic therapy.

Purpose: To assess the progression of diabetic hard exudates over an 8-week period, using a high-resolution adaptive optics camera. Design: Prospective observational study. Methods: Five eyes of three patients presenting diabetic maculopathy with hard exudates were studied. An area of clinically visible exudates was imaged sequentially using SD-OCT and high-resolution flood illumination adaptive optics for 2 months, on a weekly basis. A time-lapse video was obtained for each eye studied. Changes in terms of surface, number of free elements (foci), and central macular thickness were recorded. Results: Short-term modifications in terms of disposition, size, and number of exudates were observed. Two patterns of progression were identified: two eyes showed exudate dislocation concomitant with the regression of the underlying macular edema, with hard exudates being progressively replaced by a multitude of smaller foci. These exudates were labeled resorption exudates. In three other eyes with persistent diabetic macular edema, foci aggregated into larger exudates. Conclusion: Diabetic hard exudate changes occurred over a short period of time but were not assessable clinically. Adaptive optics was able to document these subtle changes precisely. Further studies using this imaging modality may improve our understanding of the natural history of exudates and eventually help assess the efficacy of the various treatments available such as lipid-lowering drugs and anti-VEGFs injections.

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