Exudative AMD subtypes and eligibility for treatment with ranibizumab

Abstract

Purpose To ascertain the proportion of patients with neovascular age-related macular degeneration (AMD) eligible for intravitreal treatment with monoclonal antibodies to vascular endothelial growth factor, on the basis of inclusion criteria used in pivotal clinical trials. Methods We scrutinised an imaging database and extracted all fluorescein angiograms (FAs) captured between 1 January and 31 December 2001. Of the 1083 FA, we found 184 where features of AMD in one or both eyes that were observed. In 130 eyes with neovascular AMD, we measured the area of choroidal neovascularisation (CNV) and retinal angiomatous proliferation (RAP). If contiguous to the area of neovascularisation, any areas of blood, exudate, blocked fluorescence, fibrosis, and atrophy were also measured. Descriptive statistics on lesion location, size, and composition were generated and v 2 -tests were used to test for associations. Results Of 130 eyes with neovascular AMD, a subfoveal CNV was present in over 75%. Overall, 24.6% were wholly or predominantly classic, and the remainder minimally classic or occult. Of this latter group, RAPs constituted nearly a third and were significantly associated with co-existent pigment epithelial detachment (PED). Using MARINA and ANCHOR study criteria, less than 50% would have been eligible for clinical trials for antiangiogenic therapy. Conclusions The majority of CNV were ineligible for treatment with antiangiogenic therapies when assessed solely on angiographic features. RAPs accounted for some one-third of lesions classified as minimally classic or occult at presentation, and the majority of these would have been ineligible for inclusion in the pivotal randomized control trials.

Patterns of Fundus Autofluorescence Defects in Neovascular Age-Related Macular Degeneration Subtypes

“…5 Retinal angiomatous proliferation has been reported to account for 15% to 20% of nAMD cases. 4,6 Phenotypic variants of nAMD have different pathophysiology and clinical courses. Polypoidal choroidal vasculopathy is characterized by orange to reddish polypoidal lesions arising from the choroidal vasculature beneath the retinal pigment epithelium (RPE).…”

Drusen characteristics of type 2 macular neovascularization in age-related macular degeneration

“…So far, drusen characteristics were mainly investigated in type 1 MNV [ 1 , 2 , 14 – 16 ]. Type 2 and mixed type MNV with a preponderance towards type 2 – formerly known as classic or predominantly classic choroidal neovascularization - were observed in 11.5–24.6% in the era of FA alone [ 17 – 20 ]. SD-OCT imaging led to a deeper knowledge of the neovascular anatomy as well as the aggregation of extracellular debris [ 11 ].…”

Drusen Characteristics of Type 2 Macular Neovascularization in Age-related Macular Degeneration

“…27 (3.2%) of them were compromised by type 2 MNV and as such is referred to as a rare condition in nAMD. Type 2 and mixed type MNV with a preponderance towards type 2 -formerly known as classic or predominantly classic choroidal neovascularization -were observed in 11.5% -24.6% in the era of FA alone [24][25][26][27]. SD-OCT imaging led to a deeper understanding of the neovascular anatomy as well as the aggregation of an extracellular debris [9].…”