Abstract
PurposeTo quantitatively investigate the role of deep capillary plexus (DCP) in patients affected by type 3 macular neovascularization (MNV), compared to patients with reticular pseudodrusen (RPD) eyes and healthy controls, using optical coherence tomography angiography (OCTA).MethodsIn this prospective observational study, a total of seventy-eight eyes of 78 patients were included. Group 1 consisted of 40 eyes of 40 patients with stage 1 of type 3 MNV (22 males, 18 females, mean age 73.7, SD ± 6.60) and group 2 included 38 eyes of 38 patients with RPD (17 males, 21 females, mean age 73.2, SD ± 4.55). The control group included 40 eyes of 40 healthy subjects (20 males, 20 females, mean age 71.4, SD ± 6.36 years). We evaluated the retinal vessel density (VD) of superficial capillary plexus (SCP) and deep capillary plexus (DCP) using OCTA.ResultsPatients with diagnosis of type 3 MNV showed statistically lower values of VD in DCP with respect to controls and to RPD group (p < 0.001), while there were no statistical differences between RPD and control group in macular region. No significant differences in VD of SCP were detected among the three study groups.ConclusionOCTA provides a reproducible, non-invasive detailed quantitative analysis of retinal vascular features and changing in early-stage type 3 MNV patients, which allowed to shed the light on the main role of DCP ischemia in the development of type 3 MNV.
Highlights
Retinal vascular anomalous complex was first described by Hartnett et al [1] in 1992 as a distinct form of neovascularization (NV) in patients with age-related macular degeneration (AMD)
best-corrected visual acuity (BCVA) was significantly impaired in type 3 macular neovascularization (MNV) patients with respect to other groups (p < 0.001) while it did not differ between reticular pseudodrusen (RPD) patients and controls (Table 1)
Different results were found in DPC analysis that revealed statistically lower values of vessel density (VD) in type 3 MNV patients with respect to controls (p < 0.001) while there were no statistical differences between the RPD group and controls in each macular sector (Fig. 1)
Summary
Retinal vascular anomalous complex was first described by Hartnett et al [1] in 1992 as a distinct form of neovascularization (NV) in patients with age-related macular degeneration (AMD). Several hypotheses concerning the origin of this lesion have been postulated. Yannuzzi et al [2] introduced the term retinal angiomatous proliferation (RAP), proposing an intraretinal origin of the NV. The authors described an abnormal proliferation of vessels in the middle and inner retina, which spread into the sub-retinal space and eventually communicated with choroidal vessels—the socalled retinal-choroidal anastomosis (RCA) [2]. Gass et al [3] in 2003 hypothesized a choroidal origin and referred to these vascular anomalous complex as occult chorioretinal anastomosis. The term type 3 NV, subsequently introduced by Freund et al [4], expanded the Gass choroidal neovascularization (NVC) classification system omitting its origin
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