Morphometric Analysis of Angiograms of Exudative Lesions in Age-RelatedMacular Degeneration

Abstract

Objectives: To analyze the morphometric composition of lesion components in exudative age-related macular degeneration and to study the relationships between individual lesion components and choroidal neovascularization (CNV) subtype, at 2 time points. Methods: Morphometric analysis of 98 sets of angiograms separated by an interval of at least 3 weeks, with no treatment delivered in the intervening period between angiograms. Area measurements of individual lesion components were made from digitally captured angiograms. Choroidal neovascularizations were classified into subtypes based on the proportions of classic CNV. Fully corrected distance visual acuity measured on log-MAR Early Treatment of Diabetic Retinopathy Study charts was available at baseline and at a subsequent visit in 78 subjects. Data were analyzed using parametric and nonparametric tests, linear regression, and McNemar test of equal proportions. Results: Wholly and predominantly classic CNVs were significantly smaller at initial presentation than minimally classic or occult with no classic CNVs. Lesions containing blood and lipid were also significantly larger than lesions not exhibiting these features. Lesions containing any classic CNV expanded at a significantly greater rate than lesions without classic CNV. Approximately 40% of lesions categorized as wholly classic CNV converted to predominantly classic CNV between baseline and the next follow-up visit. Conclusion: The presence of classic leakage in exudative age-related macular degeneration is the most important risk factor for rapid expansion of CNV.

Visual and Morphologic Outcomes in Eyes with Hard Exudate in the Comparison of Age-Related Macular Degeneration Treatments Trials

“…31 This association, although not statistically significant, was also observed in another study that suggested that the presence of HE in NVAMD was related to large lesion size and occult leakage. 32 CNV and the total CNV lesion areas (comprising the CNV and confluent hemorrhage, blocked fluorescence, serous pigment epithelial detachments SPED ) in CATT were larger in eyes that had hard exudates. Occult type of CNV was also more common in eyes having HE although this was not statistically significant.…”

The short-term effects of aflibercept on the size of choroidal neovascularization lesion in treatment-resistant neovascular age-related macular degeneration as determined by spectral-domain optical coherence tomography

“…According to the probability of CNV subtype conversion during/after ranibizumab therapy or over time, our cases might not reflect the characteristics of treatment‐naïve CNVs. A morphometric analysis of 98 sets of angiograms separated by an interval of at least 3 weeks, without receiving any treatment in the intervening period between angiograms showed that approximately 40% of lesions categorized as wholly classic CNV converted to predominantly classic CNV between baseline and the next follow‐up visit . Therefore, in our study, categorization of the CNV subtypes was based on the angiograms prior to initial ranibizumab therapy.…”

Combined cases of polypoidal choroidal vasculopathy and typical age-related macular degeneration

“…The lesion area was defined as the area of leakage caused by neovascularization and features obscuring the boundaries, including blocked fluorescence due to blood, thick exudate, hypertrophic retinal pigment epithelium (RPE), and associated pigment epithelial detachment (PED) on FA. The lesion area was measured in disc areas (DA), with one DA calculated as 2.54 mm 2 based on a standard disc diameter of 1.8 mm [1,18]. All cases were observed by optical coherence tomography (OCT) to confirm RPE elevation and retinal morphologic changes.…”