Widespread choroidal thickening and abnormal midperipheral fundus autofluorescence characterize exudative age-related macular degeneration with choroidal vascular hyperpermeability

Abstract

PurposeTo investigate the clinical findings that characterize exudative age-related macular degeneration (AMD) with choroidal vascular hyperpermeability (CVH).DesignRetrospective comparative study.ParticipantsForty-eight consecutive patients attending the outpatient clinic of Tokyo University Hospital between May 2013 and July 2013.MethodsThe presence or absence of CVH was determined with indocyanine green angiography performed at the latest visit. When CVH was observed, the eye was categorized as CVH(+) AMD, otherwise it was categorized as CVH(-) AMD. Using high-penetration optical coherence tomography, we measured choroidal thickness at the fovea and at four midperipheral areas (mean choroidal thickness at points on 6- and 9-papilla diameter circles superior, inferior, temporal, and nasal to the fovea). Ultrawide field retinal imaging was used to investigate abnormalities in midperipheral fundus autofluorescence (FAF). Choroidal thickness and the proportion of FAF abnormalities were compared between the CVH(+) AMD and CVH(−) AMD eyes and between eyes with polypoidal choroidal vasculopathy and typical AMD. Multiple regression analysis was used to control for treatment history and other characteristics.ResultsCVH was observed in 17 cases. Choroidal thickness was higher in the CVH(+) AMD eyes than in the CVH(−) AMD eyes at the fovea (325 μm versus 229 μm, respectively; P=0.0010, t-test), superior point (277 μm versus 215 μm, respectively; P=0.0021, t-test), inferior point (225 μm versus 161 μm, respectively; P=0.0002, t-test), and nasal point (202 μm versus 165 μm, respectively; P=0.042, t-test). The significance was maintained after controlling for possible confounders. The choroid was thicker at the fovea and at the inferior point in polypoidal choroidal vasculopathy than in typical AMD. The rate of midperipheral FAF abnormality was significantly higher in the CVH(+) AMD eyes than in the CVH(−) AMD eyes (82% versus 48%, respectively; P=0.031).ConclusionAMD with CVH is associated with widespread choroidal thickening and peripheral FAF abnormalities.

Evaluation of peripheral fundus autofluorescence in eyes with wet age-related macular degeneration

“…The treatments did not affect the frequencies of the abnormal peripheral FAF patterns in eyes with wet AMD. To the best of our knowledge, the previous findings regarding abnormal peripheral FAF patterns in patients with wet AMD were reported mainly in Caucasian patients,19–21 while only a few findings were described solely in Asian patients 18…”

“…Previous studies have reported three major patterns of the abnormal peripheral FAF 18,20. First, the mottled pattern of decreased FAF was characterized by diffuse areas of irregular hypoautofluorescence, which corresponded to RPE depigmentation in 76.5% of eyes with wet AMD, according to Tan et al20 In a study of the fellow eyes of Japanese patients with unilateral wet AMD, Sasaki et al29 reported that retinal pigment abnormalities without drusen were critical in the development of PCV.…”

“…Tan et al20 and Nomura et al18 previously reported that the frequencies of abnormal peripheral FAF in patients with wet AMD were 86.0% and 60.4%, respectively. Although dry and wet AMD were not differentiated, Witmer et al21 and Heussen et al12 reported 63.6% and 73.9%, respectively, as the frequencies of the abnormal peripheral FAF patterns in eyes with AMD.…”

“…Currently, a wide-field imaging instrument, the Optos ® 200Tx (Optos plc, Dunfermline, Scotland, UK), allows noninvasive, nonmydriatic scanning of the fundus, including the periphery 12–17. Some studies have reported abnormal peripheral FAF in patients with AMD examined using the wide-field retinal imaging technique 18–21…”

Intravitreal aflibercept for ranibizumab-resistant exudative age-related macular degeneration with choroidal vascular hyperpermeability

“…One study [11] reports that in eyes with choroidal neovascularization (CNV) accompanied by CVH, type 1 CNV was more frequent than previously thought, while type 2 CNV and polypoidal lesions were sometimes observed. These studies led us to hypothesize that exudative AMD eyes with CVH may have different characteristics [12] and Electronic supplementary material The online version of this article (doi:10.1007/s10384-015-0387-z) contains supplementary material, which is available to authorized users. respond differently to those without CVH, regardless of whether it is tAMD or PCV.…”