Pachychoroid neovasculopathy has clinical properties that differ from conventional neovascular age-related macular degeneration

Abstract

To determine the clinical properties of pachychoroid neovasculopathy (PNV) that differ from conventional neovascular age-related macular degeneration (nAMD) and suggest that they are different clinical entities. To accomplish this, we reviewed the medical records of 100 consecutive patients diagnosed with nAMD. All of the patients were Japanese, and their mean age was 75.5 years. There were 72 men and 28 women. For the bilateral cases, only the right eye was analyzed. An eye was diagnosed with PNV when a macular neovascularization (MNV) was detected just above the dilated choroidal vessels. The Indocyanine green angiographic (ICGA) and en face optical coherence tomographic (OCT) images were used to assess the vertical symmetry of the medium and large choroidal vessels. The subfoveal choroidal thickness (SCT) was also measured manually in the OCT images. After reclassification, there were 29 (29%) patients with typical nAMD (25 with type 1 MNV, 4 with type 2 MNV), 43 (43%) with PNV, 21 (21%) with polypoidal choroidal vasculopathy, and 7 (7%) with retinal angiomatous proliferation. Of the 43 PNV, 17 (39.5%) had polypoidal lesions and 26 (60.5%) had no polypoidal lesions. The percentage of eyes with vertical asymmetry of the medium and large choroidal vessels was significantly greater in the 35 PNV (81.4%) than in the 16 non-PNV (28.1%; P < 0.01) cases. The mean SCT was significantly thicker in the PNV eyes than in the non-PNV eyes (298 ± 96 μm vs. 228 ± 82 μm; P < 0.01). The response of PNV to anti-vascular endothelial growth factor treatments was better than that of non-PNV eyes [higher dry macula rate after the loading period (90.9% vs. 59.1%), fewer total number of injections (11.0 ± 2.9 vs. 13.4 ± 3.2), and longer treatment intervals for the anti-VEGF therapy (8.4 ± 3.1 vs. 13.4 ± 3.2 weeks) at 2 years (all P < 0.01)]. These differences in the morphology and response to anti-VEGF treatments suggest that PNV is a separate clinical entity to conventional nAMD.

Characteristics of Eyes With Neovascular Age-Related Macular Degeneration Requiring Frequent Anti-vascular Endothelial Growth Factor Injections

“…This study did not focus specifically on pachychoroid neovasculopathy. Recently, it has been pointed out that pachychoroid neovasculopathy can be confused with AMD and that the response to anti-VEGF therapy is different from that of AMD [30]. In the current study, SCT was measured, and although the choroid was slightly thicker in eyes treated at our hospital initially, there was no significant difference.…”

Differences in Central and Peripheral Choroidal Thickness among the Subtypes of Age-Related Macular Degeneration in an Asian Population

“…However, RAP tends to occur in older individuals; therefore, it is possible that a thin choroid might simply be due to older age. Similarly, this could also be argued in cases of PNV, which tend to occur in younger individuals [34]. Therefore, to determine whether there were significant differences in the choroidal thicknesses among the disease types, we considered the effects of age and axial length when comparing the choroidal thicknesses among the different AMD subtypes.…”