Abstract
The aim of this study was to explore the relative prevalence and clinical differences between age-related macular degeneration (AMD) and pachychoroid disease in patients older than 50 years with newly diagnosed exudative neovascular maculopathy, and also assess the rate of misdiagnosis between these two disorders. In this retrospective observational study, we reviewed data from patients 50 years of age and older with newly diagnosed treatment-naïve exudative macular neovascularization (MNV) secondary to AMD or pachychoroid disease. Of the 139 patients (139 eyes) who fulfilled the inclusion criteria, 35 patients were graded as being affected by pachychoroid disease complicated by exudative MNV and 104 subjects had neovascular AMD. Therefore, prevalence of pachychoroid disease complicated by exudative MNV was 25.2% (confidence interval—CI 18.2–33.2%). Mean ± SD age was 67.0 ± 8.8 years in the pachychoroid disease group and 80.6 ± 6.6 years in the neovascular AMD group (P < 0.0001). At baseline, BCVA was better in patients with pachychoroid disease complicated by exudative MNV (0.4 ± 0.3 LogMAR vs. 0.7 ± 0.5 LogMAR, P = 0.003). At the 1-year follow-up visit, BCVA was still better in patients with pachychoroid-associated MNV (0.34 ± 0.32 LogMAR vs. 0.59 ± 0.52 LogMAR; P = 0.005). In our study cohort, 19 patients were graded to be affected by pachychoroid disease complicated by exudative MNV even though a diagnosis of neovascular AMD was erroneously reported in their medical records at baseline. In conclusion, pachychoroid disease is a frequent cause of exudative MNV in aged patients with a high rate of misdiagnosis. A correct diagnosis may be important as these two disorders differ in terms of clinical characteristics and prognosis.
Highlights
The pachychoroid disease spectrum incorporates different entities that include central serous chorioretinopathy (CSC)[8,9], pachychoroid pigment e pitheliopathy[10], focal choroidal e xcavation[11], peripapillary pachychoroid syndrome[12], pachychoroid n eovasculopathy[13,14], and pachychoroid aneurysmal type 1 macular neovascularization[13]
We explored consecutive patients older than 50 years with newly diagnosed treatment-naïve exudative neovascular maculopathy
In our study cohort of Caucasian patients, pachychoroid disease was revealed to be a frequent cause of exudative macular neovascularization (MNV), as this entity may represent more than one quarter of all cases
Summary
The pachychoroid disease spectrum incorporates different entities that include central serous chorioretinopathy (CSC)[8,9], pachychoroid pigment e pitheliopathy[10], focal choroidal e xcavation[11], peripapillary pachychoroid syndrome[12], pachychoroid n eovasculopathy[13,14], and pachychoroid aneurysmal type 1 macular neovascularization[13]. Pang and Freund[16] reported cases of type 1 MNV developing in eyes with pachychoroid pigment epitheliopathy and termed this condition as “pachychoroid neovasculopathy”. Differentiating pachychoroid disease complicated by exudative MNV from AMD can be challenging, as these two conditions may have similar characteristics on dye angiographies (fluorescein angiography and indocyanine green angiography, FA and ICGA, respectively) and both disorders usually affect patients older than 50 years. Improvements in choroidal imaging and advances in our understanding of the pachychoroid disease spectrum have enhanced our capability to differentiate cases with MNV-associated pachychoroid disease from neovascular AMD. In this retrospective study we investigated patients older than 50 years with newly diagnosed treatment-naïve exudative MNV. We investigated differences in terms of demographics, clinical characteristics, and prognosis between these two disorders
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