Abstract
Choroidal neovascular (CNV) lesions in younger patients are often accompanied by the appearance of a surrounding ring of pigment that is associated with disease regression or slowed disease progression. In older patients with age-related macular degeneration (AMD), however, hypertrophy of the retinal pigment epithelium (RPE) is known to occur but has not previously been reported to be associated with CNV regression. This report describes the clinical course of a case series of AMD patients with pigment hypertrophy adjacent to CNV associated with stabilization of the CNV lesion. A retrospective analysis of exudative AMD patients seen by a single retina specialist over a 7-year period. Retrospective analysis of 955 exudative AMD patients revealed pigment hypertrophy associated with CNV in 33 patients. A ring of pigment surrounded CNV in 6 of these. Three representative patients are presented to illustrate the decrease in macular edema, reduced fluorescein leakage and slowed CNV progression that was associated with a pigment ring around CNV in AMD. Pigment hypertrophy was associated with blocked fluorescein leakage and exudative AMD patients with a complete pigment ring maintained stable visual acuity, macular edema, fluorescein leakage and CNV lesion size without treatment for intervals of up to 21 months. We report slowed disease progression in AMD patients who develop pigment around CNV. The slow rate of disease progression in the AMD patient subgroup having a pigment ring is a factor to consider in determining the treatment interval for exudative AMD patients.
Highlights
A rapid loss of vision in exudative age-related macular degeneration (AMD) occurs when choroidal neovascular membranes (CNV) grow into the overlying retinal pigment epithelium (RPE) and neurosensory retina
In this case series, 3 AMD patients developed a ring of pigment around CNV which was accompanied by decreased fluorescein leakage and slowed CNV growth in the direction of the pigment
Our case series suggests that the presence of pigment hypertrophy surrounding CNV can be associated with slowed growth or regression of CNV in patients with AMD
Summary
A rapid loss of vision in exudative age-related macular degeneration (AMD) occurs when choroidal neovascular membranes (CNV) grow into the overlying retinal pigment epithelium (RPE) and neurosensory retina. Young patients with CNV secondary to myopia[2], histoplasmosis[3], rubella[4] or other causes[5,6] often undergo stabilization that is accompanied by pigment hypertrophy developing around the CNV lesion. Pigment hypertrophy is well known to occur in AMD patients[1,7], there have been no reports on pigment hypertrophy associated with CNV regression in AMD. We report 3 AMD patients who developed a ring of hyperpigmentation around CNV during treatment of the CNV lesion that was accompanied by CNV regression even after the treatment was withdrawn for periods of up to 21 months
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