Abstract
To develop a novel scoring system aiming at guiding the differential diagnosis between macular neovascularization secondary to pachychoroid disease (pMNV) and neovascular age-related macular degeneration (AMD) in patients aged 50 years and older. In this retrospective study performed at University Vita-Salute San Raffaele (Milan, Italy) and Créteil University Eye Clinic (Créteil, France), we enrolled patients 50 years of age and older, visited between January 2017 and January 2019, who were diagnosed with either treatment-naïve pMNV or neovascular AMD. At the time of diagnosis, all patients underwent a comprehensive ophthalmologic evaluation, spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, and optical coherence tomography angiography. Univariate comparison between pMNV and neovascular AMD groups was performed to identify the main clinical predictors for pMNV. The selected predictors were taken into a binomial logistic regression and eventually served as the basis for the development of InCASEOf scoring system. Receiver operating characteristic (ROC) curves were used to study the model performance. Forty-eight right eyes from 48 patients with pMNV and 39 right eyes from 39 patients with neovascular AMD were considered in this study. Age (+ 2 points), sex (+ 2 points), choroidal thickness (+ 2 points), early pachyvessels (+ 2 points), and evidence of MNV at OCTA (+ 3 points) turned out to be predictors for pMNV. Four additional factors significant at univariate analysis were considered: type 2 and type 3 MNVs and presence of intraretinal fluid (− 0.5 points each), and presence of subretinal fluid (+ 0.5 points). InCASEOf scoring system was built with a high score of 11.5 points. The cutoff value of 6.5 showed good accuracy in separating pMNVs from neovascular AMDs. InCASEOf is a straightforward clinical scoring system, accessible to comprehensive ophthalmologists, with the purpose of enabling easy distinction and expert-like diagnosis of pMNV and neovascular AMD in patients aged 50 years or older.
Highlights
Among the investigated factors, age, sex, choroidal thickness, MNV type, sub-retinal fluid, intra-retinal fluid, early pachyvessels, and evidence of MNV at OCTA were shown to be significant risk factors for pMNV by univariate analysis
A statistically significant difference between the two study groups was detected in terms of age, sex, sub-foveal choroidal thickness (SFCT) and vPDT treatment
Binomial logistic regression was performed to ascertain the effects of these factors on the likelihood that participants have pMNV rather than neovascular MNV (Table 3)
Summary
This study was a retrospective cross-sectional analysis. The Institutional Review Board (IRB) of Creteil University Eye Clinic and University Vita-Salute San Raffaele approved the study and informed consent was obtained from all subjects of both centers, in agreement with the Declaration of Helsinki for research involving human subjects. Neovascular AMD was diagnosed if the following criteria were met, as previously r eported[2,12]: (1) patients with MNV and other findings corresponding to Age-Related Eye Disease Study levels 2, 3, and 4 (extensive hard drusen, soft drusen [intermediate, ≥ 63 and < 125 μm; large, ≥ 125 μm], reticular pseudodrusen, focal hyperpigmentation, or RPE and outer retinal atrophy), (2) subfoveal choroidal thickness < 200 μm in at least one eye, or no CSC/pachychoroid pigment epitheliopathy characteristics. The readers established the diagnosis in an independent and blinded fashion, according to the criteria mentioned above (see Definition of Pachychoroid-associated MNV and Neovascular AMD) Thereafter, they met to compare the level of agreement, and disagreements were resolved by further discussion and open adjudication to yield a single assessment for each case. The abstract of this research has been presented as Free Paper at EURETINA Virtual Congress 2021
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
