Progression from Type 2 Macular Neovascularization to Fibrovascular Pigment Epithelial Detachment.

Hoang Mai Le,Camille Jung,Oudy Semoun,Gérard Mimoun,Salomon Y Cohen,Eric H Souied

doi:10.3390/vision5020016

Abstract

The aim of this study was to report unusual progression of type 2 macular neovascularization (MNV) associated with age-related macular degeneration (AMD), high myopia or angioid streaks. Retrospective multicentric observational case series data were used. Eyes that progressed from type 2 MNV secondary to AMD, high myopia or angioid streaks to fibrovascular pigment epithelial detachment (PED) were included. A total of 29 treatment-naive eyes from 29 patients with type 2 MNV secondary to AMD (n = 14), high myopia (n = 10) or angioid streaks (n = 5) that progressed to a fibrovascular PED on Spectral Domain-Optical Coherence Tomography were used. This progression occurred within 3 months after anti-VEGF therapy initiation. Logarithm of minimum angle of resolution (LogMAR) visual acuity improved significantly after anti-VEGF therapy, from 0.55 (SD ± 0.30) (20/63–20/80) at baseline to 0.30 (20/40) at 3 months, and 0.33 (20/40) at the final follow-up (mean follow up: 3.68 years). Mean number of intravitreal injections per year for patients with a total follow-up ≥ 12 months (n = 24) was 4.3 ± 2.1 per year. Progression from type 2 MNV to a fibrovascular PED may occur in patients suffering from AMD, high myopia or angioid streaks. This progression appears early after initiation of anti-VEGF therapy and is associated with a favorable visual and anatomical outcome, at least on a short follow up basis.

Highlights

In the Western world, age-related macular degeneration (AMD) is the leading cause of visual loss in patients older than 50 [1,2]
Inclusion criteria included patient age > 18, treatment-naïve type 2 macular neovascularization (MNV) at baseline secondary to AMD, pathologic myopia or angioid streaks that progressed towards a fibrovascular pigment epithelial detachment (PED) after anti-VEGF therapy
We reported the initial aspect of the type 2 MNV based on Spectral Domain-Optical Coherence Tomography (SD-OCT) and fluorescein angiography (FA), performed at initial examination in our center

Summary

Introduction

In the Western world, age-related macular degeneration (AMD) is the leading cause of visual loss in patients older than 50 [1,2]. In neovascular AMD, ingrowth of macular neovascularization (MNV) is responsible for severe visual loss due to exudation, bleeding or scarring [3]. Anti-VEGF intravitreal injection is the most commonly performed ophthalmic procedure for the treatment of different retinal diseases such as neovascular AMD, diabetic retinopathy, retinal vein occlusion and secondary neovascularization in tumoral or inflammatory diseases [4,5,6,7,8]. In neovascular AMD, it has been shown that functional prognosis worsens if treatment by anti-VEGF intravitreal injections is delayed and strongly correlates with visual acuity at the time of the first injection [9]. Various molecules are available (ranibizumab, aflibercept and bevacizumab) and all have been proven to be safe and efficient for controlling MNV [4]

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