Abstract
The phenotypes of neovascular age-related macular degeneration (nAMD) are recognized as differing between Caucasian and Asian patients. Pachychoroid is thought to be more prevalent in Asians than in Caucasians, and may be involved in the development of nAMD in Asian patients. Therefore, we investigated the clinical characteristics and pachychoroid incidence in Japanese patients with nAMD. We retrospectively analyzed 385 eyes of 370 consecutive Japanese patients with treatment naïve nAMD. According to the nAMD nomenclature, type 1 macular neovascularization (MNV) was observed in 132 eyes (34.3%), polypoidal choroidal vasculopathy (PCV) in 137 (35.6%), mixed type 1 and type 2 MNV in 32 (8.3%), type 2 MNV in 43 (11.2%), and type 3 MNV in 41 (10.6%). Pachychoroid was seen in 58.3% of type 1 MNV, 75.2% of PCV, 34.4% of mixed type 1 and type 2 MNV, 14.0% of type 2 MNV, and 0% of type 3 MNV. Compared to nAMD patients without pachychoroid (188 eyes), those who had nAMD with pachychoroid (197 eyes) were significantly younger, had a higher proportion of males, greater central choroidal thickness, and a higher frequency of macular vortex vein anastomoses (all P < 0.001). Furthermore, drusen subtypes differed significantly between the two groups (P < 0.001). These results suggest that most Japanese nAMD patients might have type 1 MNV or PCV. Moreover, in approximately half of patients, nAMD might be associated with pachychoroid, and choroidal congestion may be involved in the development of MNV in these cases.
Highlights
The phenotypes of neovascular age-related macular degeneration are recognized as differing between Caucasian and Asian patients
Soft drusen were observed in 9 eyes, pseudodrusen in 4, and pachydrusen in 110, while 82 eyes had no drusen. Compared to those who had neovascular age-related macular degeneration (nAMD) without pachychoroid, patients who had nAMD with pachychoroid were significantly younger, the proportion of males was higher, central choroidal thickness (CCT) were greater, and the frequency of intervortex venous anastomosis was higher
Pachychoroid was seen in 58.3% of type 1 macular neovascularization (MNV), 75.2% of polypoidal choroidal vasculopathy (PCV), 34.4% of mixed type 1 and type 2 MNV, 14.0% of type 2 MNV, and 0% of type 3 MNV
Summary
The phenotypes of neovascular age-related macular degeneration (nAMD) are recognized as differing between Caucasian and Asian patients. According to the nAMD nomenclature, type 1 macular neovascularization (MNV) was observed in 132 eyes (34.3%), polypoidal choroidal vasculopathy (PCV) in 137 (35.6%), mixed type 1 and type 2 MNV in 32 (8.3%), type 2 MNV in 43 (11.2%), and type 3 MNV in 41 (10.6%). Drusen subtypes differed significantly between the two groups (P < 0.001) These results suggest that most Japanese nAMD patients might have type 1 MNV or PCV. The proportions of male and PCV patients are higher among Asians than Caucasians These findings suggest that the mechanisms of MNV development in nAMD might differ, at least in some respects, between Asian and Caucasian patients. We suggest that chronic ischemia of the choriocapillaris secondary to vortex vein congestion might be involved in the pathogenesis of pachychoroid spectrum diseases
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