Typical Neovascular Age-related Macular Degeneration Research Articles

Latest Developments in Polypoidal Choroidal Vasculopathy: Epidemiology, Etiology, Diagnosis, and Treatment.

Polypoidal choroidal vasculopathy (PCV) is a condition characterized by multiple, recurrent, serosanguineous pigment epithelial detachments, and neurosensory retinal detachments due to abnormal aneurysmal neovascular lesions. It is generally considered as a variant of neovascular age-related macular degeneration, but there are some differences between the clinical presentation, natural history, and treatment response between patients with PCV and typical neovascular age-related macular degeneration patients. Over the past decade, new research and technological advancements have greatly improved our understanding of the PCV disease process and the management of PCV. This review aims to summarize the recent research findings to highlight the epidemiology, pathogenesis, genetics, the application of various diagnostic tools for PCV, and the available treatment options for PCV.

Genetic factors associated with response to as-needed aflibercept therapy for typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy

In the present study, we investigated the association between susceptible genetic variants to age-related macular degeneration (AMD) and response to as-needed intravitreal aflibercept injection (IAI) therapy for exudative AMD including both typical neovascular AMD and polypoidal choroidal vasculopathy (PCV) over 12-months. A total of 234 patients with exudative AMD were initially treated with 3 monthly IAI and thereafter as-needed IAI over 12 months. Seven variants of 6 genes including ARMS2 A69S (rs10490924), CFH (I62V:rs800292 and rs1329428), C2-CFB-SKIV2L(rs429608), C3 (rs2241394), CETP (rs3764261) and ADAMTS-9 (rs6795735) were genotyped for all participants using TaqMan technology. After adjusting for age, gender, baseline BCVA and AMD subtype, A (protective) allele of C2-CFB-SKIV2L rs429608 was associated with visual improvement at 12-month (P = 0.003). Retreatment was associated with T(risk) allele of ARMS2 A69S (P = 2.0 × 10−4; hazard ratio: 2.18:95%CI: 1.47-3.24) and C(risk) allele of CFH rs1329428 (P = 2.0 × 10−3; hazard ratio: 1.74:95%CI: 1.16–2.59) after adjusting for the baseline confounders. The need for additional injections was also associated with T allele of ARMS2 A69S (P = 1.0 × 10−5) and C allele of CFH rs1329428 (P = 3.0 × 10−3) after adjusting for the baseline confounders. The variants of ARMS2 and CFH are informative for both physicians and patients to predict recurrence and to quantify the need for additional injections.

Using optical coherence tomography angiography in assessment of the anti-vascular endothelial growth factor effect for pathological vascular tissue in age-related macular degeneration and polypoidal choroidal vasculopathy.

Using optical coherence tomography angiography to assess and compare changes in pathological vascular tissue, including choroidal neovascularization in neovascular age-related macular degeneration and polypoidal complex in polypoidal choroidal vasculopathy, after treatment with anti-vascular endothelial growth factor. This is a retrospective observational case series study. Clinical data were collected, including that on the best-corrected visual acuity and images of spectrum domain optical coherence tomography and optical coherence tomography angiography of consecutive patients with macula-involved lesions, active pathological vascular tissue in neovascular age-related macular degeneration, and polypoidal complex in polypoidal choroidal vasculopathy who were treated with anti-vascular endothelial growth factor injection. The primary outcome measures were the lesion area, flow density, and flow area of the pathological vascular tissue obtained in optical coherence tomography angiography before treatment, as well as week-1 (W1) and week-5 (W5) after treatment. The secondary outcome measures were the best-corrected visual acuity and the anatomic changes in spectrum domain optical coherence tomography at the same periods. A total of 86 eyes in 79 patients (mean age: 73.10 ± 10.10 (range = 50-91) years, 45 males (57%), of which two eyes were treatment-naïve) underwent one section of intravitreal treatment. Of which 44 eyes (40 patients) were diagnosed as typical neovascular age-related macular degeneration and 42 eyes (39 patients) as polypoidal choroidal vasculopathy. The sensitivity for detecting choroidal neovascularization in neovascular age-related macular degeneration and polypoidal complex in polypoidal choroidal vasculopathy was 75.00% (33/44) and 69.05% (29/42), respectively. There was no significant difference in the detection rate between neovascular age-related macular degeneration and polypoidal choroidal vasculopathy (p = 0.54). In the detectable group, there were significant decrease in lesion area and flow area in the optical coherence tomography angiography images after anti-vascular endothelial growth factor treatment in both the neovascular age-related macular degeneration group (lesion area: W1 = -26.94 ± 19.50%, W5 = -35.52 ± 30.85%, all ps < 0.001; flow area: W1 = -26.22 ± 25.23%, W5 = -32.24 ± 32.07%, all ps < 0.001) and the polypoidal choroidal vasculopathy group (lesion area: W1 = -25.19 ± 20.27%, W5 = -31.55 ± 27.04%, all ps < 0.001; flow area: W1 = -21.83 ± 26.29%, W5 = -28.31 ± 30.72%, all ps < 0.001). The central subfield retinal thickness in spectrum domain optical coherence tomography also showed similar amelioration in both groups. However, the flow density in optical coherence tomography angiography image and the visual outcome did not reveal any significant difference before or after intravitreal injections, and neither were there significant differences between the neovascular age-related macular degeneration and polypoidal choroidal vasculopathy groups. Concerning the effect on the optical coherence tomography angiography images of pathological vascular tissue, there were no statistical differences among different anti-vascular endothelial growth factor agents (i.e. aflibercept, ranibizumab, and bevacizumab). Our study revealed that optical coherence tomography angiography can be used noninvasively and quantitatively to assess the detailed pathologic vascular structures in both neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Our study also demonstrated that anti-vascular endothelial growth factor could effectively decrease the lesion size and flow area of both the choroidal neovascularization in neovascular age-related macular degeneration cases and the polypoidal complex in polypoidal choroidal vasculopathy cases; the effects were similar in both diseases.

Prediction of OCT images of short-term response to anti-VEGF treatment for neovascular age-related macular degeneration using generative adversarial network

Background/aimsThe aim of this study was to generate and evaluate individualised post-therapeutic optical coherence tomography (OCT) images that could predict the short-term response of antivascular endothelial growth factor therapy for...

Long‐term clinical courseafter vitrectomy for breakthrough vitreous hemorrhage secondary to neovascular age‐related macular degeneration

AbstractPurposeTo investigate the long‐term clinical course after vitrectomy for breakthrough vitreous hemorrhage secondary to neovascular age‐related macular degeneration (AMD).MethodsThis retrospective study included 45 eyes that underwent vitrectomy due to breakthrough vitreous hemorrhage secondary to neovascular AMD. The patients were divided into two groups: typical neovascular AMD group and polypoidal choroidal vasculopathy (PCV) group. Within each group, the status of the eye within 6 months after the surgery and that at the final follow‐up was identified. The visual acuity at the final visit was additionally compared between the two groups.ResultsThe patients were followed up for a mean period of 39.9 ± 19.4 months after the surgery. In the typical neovascular AMD group (n = 17), re‐bleeding requiring vitrectomy was noted in four eyes and extensive scar formation was noted in six eyes within 6 months after the surgery. At the final visit, treatment was discontinued due to poor visual outcome in 12 eyes. In the PCV group (n = 28), re‐bleeding requiring vitrectomy was noted in one eye, and extensive scar formation was noted in four eyes within 6 months after the surgery. At the final visit, treatment was discontinued in eight eyes. The visual acuity at the final visit was significantly better in the PCV group (p = 0.003).ConclusionsThe long‐term clinical course after vitrectomy for breakthrough vitreous hemorrhage was markedly different between typical neovascular AMD and PCV, showing significantly better long‐term visual outcomes in PCV.

Association of imaging factors derived from convolutional neural network with visual outcomes in age-related macular degeneration and polypoidal choroidal vasculopathy

We investigated the association of visual outcome in typical neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) with or without pachychoroid with lesion areas on optical coherence tomography (OCT) quantified by convolutional neural network (CNN) analysis. Treatment-naïve 132 nAMD and 45 PCV eyes treated with ranibizumab or aflibercept for at least 12 months were retrospectively reviewed. Significant factors, including intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED) and subretinal hyperreflective material (SHRM) area quantified by CNN at baseline and 12 months, were analyzed by logistic regression analyses for 3-line visual gain or maintenance of 20/30 Snellen vision. Visual gain at the final visit in nAMD was associated with a smaller SHRM at baseline (OR 0.167, P = 0.03), greater decrease in SRF and SHRM from baseline to month 12 (OR 1.564, P = 0.02; OR 12.877, P = 0.01, respectively). Visual gain in nAMD without pachychoroid was associated with a greater decrease in SRF and SHRM (OR 1.574, P = 0.03, OR 1.775, P = 0.04). No association was found in nAMD with pachychoroid and any type of PCV. Greater decrease in SRF and SHRM from baseline to month 12 was associated with favorable visual outcomes in nAMD without pachychoroid but not in nAMD with pachychoroid and PCV.

Noninvasive multimodal imaging in diagnosing polypoidal choroidal vasculopathy

PurposeTo investigate the diagnostic accuracy of noninvasive multimodal imaging methods in diagnosing polypoidal choroidal vasculopathy (PCV) and distinguishing PCV from typical neovascular age-related macular degeneration (nvAMD).MethodsRetrospective study. Imaging features of noninvasive multimodal imaging methods, including fundus photography (FP), B-scan optical coherence tomography (OCT), en face OCT, OCT angiography, and autofluorescence, of 103 eyes with PCV or typical nvAMD were reviewed. Diagnostic strategy was established based on imaging features and was validated in other 105 eyes with PCV or typical nvAMD.ResultsFeatures of subretinal orange nodule on FP, thumb-like PED on OCT, notched PED on OCT, bubble sign on OCT, and Bruch’s membrane depression under serosanguinous PED on OCT were more common. When the diagnostic strategy of using at least 2 of 5 features was performed, there is 0.88 sensitivity and 0.92 specificity for diagnosing PCV. The results of the validation test further confirmed the diagnostic strategy with 0.94 sensitivity and 0.93 specificity.ConclusionsNoninvasive multimodal imaging, especially FP and B-scan OCT, provide high sensitivity and specificity for diagnosing PCV and distinguishing PCV from typical nvAMD, when at least 2 of 5 suggestive imaging features are present.

Sensitivity and Specificity of Potential Diagnostic Features Detected Using Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography for Polypoidal Choroidal Vasculopathy

ImportanceThe use of indocyanine green angiography (ICGA) is a criterion standard for diagnosing polypoidal choroidal vasculopathy (PCV), an endemic and common cause of vision loss in Asian and African individuals that also presents in white individuals. However, the use of ICGA is expensive, invasive, and not always available at clinical centers. Therefore, knowing the value of certain features detected using fundus photography (FP), optical coherence tomography (OCT), and fluorescein angiography (FA) to diagnose PCV without ICGA could assist ophthalmologists to identify PCV when ICGA is not readily available.ObjectiveTo explore the sensitivity, specificity, and predictive accuracy of potential diagnostic features detected using FP, OCT, and FA in diagnosing PCV without ICGA.Design, Setting, and ParticipantsDeidentified images of FP alone, OCT alone, and FA alone were graded by 3 retina specialists masked to ICGA findings for potentially diagnostic features of PCV prespecified before grading compared with the criterion standard grading of 2 other retina specialists with access simultaneously to FP, OCT, FA and ICGA. Specialists graded images of 124 eyes of 120 patients presenting between January 1, 2013, and December 31, 2016, with newly identified serous or serosanguinous maculopathy who had undergone FP, OCT, FA, and ICGA before treatment at a large referral eye center in Thailand.Main Outcomes and MeasuresSensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy from the area under the receiver operating characteristic curve (AUC).ResultsThe mean (SD) age of the patients was 57.7 (12.6) years, 52 were women, 68 were men, and the diagnosis (from ICGA) was PCV for 65 eyes (52.4%), central serous chorioretinopathy for 45 eyes (36.3%), and typical neovascular age-related macular degeneration for 12 eyes (9.7%). With the use of FP, a potential diagnostic feature for PCV was notched or hemorrhagic pigment epithelial detachment (AUC, 0.77; 95% CI, 0.70-0.85). With the use of OCT, potential diagnostic features for PCV were pigment epithelial detachment notch (AUC, 0.90; 95% CI, 0.85-0.96), sharply peaked pigment epithelial detachment (AUC, 0.86; 95% CI, 0.80-0.92), and a hyperreflective ring (AUC, 0.86; 95% CI, 0.80-0.92). When at least 2 of these 4 signs were present, the AUC was 0.93 (95% CI, 0.89-0.98), with a sensitivity of 0.95 (95% CI, 0.87-0.99), a specificity of 0.95 (95% CI, 0.82-0.97), a positive predictive value of 0.92 (95% CI, 0.83-0.97), and a negative predictive value of 0.95 (95% CI, 0.86-0.99).Conclusions and RelevanceThese data suggest that the potential diagnostic features detected using FP and OCT provide high sensitivity and specificity for a diagnosis of PCV, especially when at least 2 of 4 highly suggestive signs are present.

EVEREST study report 4: Fluorescein angiography features predictive of polypoidal choroidal vasculopathy.

ImportanceIt is important to identify features of polypoidal choroidal vasculopathy (PCV) that differentiate it from typical neovascular age‐related macular degeneration (nAMD) on various imaging modalities, including fluorescein angiography (FA).BackgroundPCV was thought to be indistinguishable from nAMD using FA alone. In real‐world practice, indocyanine‐green angiography may often be unavailable or contraindicated.DesignAnalysis of FA images from a prospective, multicentre study.ParticipantsStudy images of both PCV and nAMD patients from the EVEREST study.MethodsFA features at baseline were independently graded by masked graders (fellowship‐trained ophthalmologists) using standardized diagnostic algorithms.Main Outcome MeasuresPredictive indicators (sensitivity, specificity, positive and negative predictive values) for PCV.ResultsOf the 95 patients screened, 61 had PCV. Of the 34 screening failures, 15 were diagnosed as nAMD. Hyperfluorescent nodules on FA were observed in 80% of patients with PCV vs 20% with nAMD (P < 0.001). Blocked fluorescence on FA, which corresponded to the presence of subretinal haemorrhage, occurred more frequently among patients with PCV vs nAMD (61.7% vs 13.3%, P = 0.001). Similarly, the leakage characteristic of occult choroidal neovascularization occurred more frequently among patients with PCV vs nAMD (95.0% vs 73.3%, P = 0.026). The positive predictive value for PCV was 94.1% for hyperfluorescent nodules, 94.9% for blocked fluorescence, 83.8% for occult choroidal neovascularization and 82.0% for pigment epithelial detachment.Conclusions and RelevanceThis study demonstrated that certain FA features can be predictive of PCV and may be considered as an indication for retina specialists to perform indocyanine green angiography as confirmatory test.

Age-related differences in the prevalence of subtypes of Neovascular age-related macular degeneration in the first diagnosed eye.

To evaluate age-related differences in the prevalence of subtypes of neovascular age-related macular degeneration (AMD) in the first diagnosed eye. This retrospective, observational study included 1099 eyes of 1099 patients diagnosed with neovascular AMD. The neovascular AMD cases were classified into three subtypes: typical neovascular AMD, polypoidal choroidal vasculopathy (PCV), and type 3 neovascularization. The patients were divided into four groups, according to age: > 50 and < 60years, ≥ 60 and < 70years, ≥ 70 and < 80years, and ≥ 80years. Difference in the prevalence of three AMD subtypes was evaluated among the four age groups. In the age group > 50 and < 60years, 34 (25.0%) and 102 patients (75.0%) were diagnosed with typical neovascular AMD and PCV, respectively. In the age group ≥ 60 and < 70years, 90 (28.1%), 206 (64.4%), and 24 patients (7.5%) were diagnosed with typical neovascular AMD, PCV, and type 3 neovascularization, respectively. In the age group ≥ 70 and < 80years, the corresponding numbers were 200 (41.9%), 197 (41.3%), and 80 (16.8%), respectively; in the age group ≥80years, the corresponding values were 83 (50.0%), 39 (23.5%), and 44 (26.5%), respectively. A significant difference was observed in the prevalence of the subtypes of neovascular AMD among the four age groups (chi-square test, P < 0.001). Subtype prevalence in newly diagnosed neovascular AMD differs significantly according to age. This result suggests that different pathophysiology may be involved in the development of different subtypes of neovascular AMD.

Prognostic factors after aflibercept therapy for typical age-related macular degeneration and polypoidal choroidal vasculopathy.

To determine factors predictive of visual outcomes in eyes treated with intravitreal aflibercept injections (IAIs) for typical neovascular age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV). Retrospective, multicenter, institutional, consecutive, interventional case series. One hundred nine eyes (107 patients) with treatment-naïve neovascular AMD at 3 university hospitals were studied. After a loading phase of 3 monthly 2.0-mg IAIs, injections were administered every 2 months. The baseline clinical characteristics were investigated in relation to the 12-month visual outcomes. Changes in the mean best-corrected visual acuity (BCVA) were measured at 12 months after initiation of aflibercept therapy. Forty-five eyes (41.3%) had typical neovascular AMD, and 64 eyes (58.7%) had PCV. The changes in the mean BCVA at 12 months compared with baseline did not differ significantly (P = .737) between the 2 groups. Stepwise analysis showed that larger gains in the BCVA at 12 months were associated with poor BCVA (P < .001), no pigment epithelial detachment (P = .004), and subretinal fluid (P = .039) at baseline in eyes with typical neovascular AMD; larger gains in the BCVA were associated with poorer BCVA (P < .001), presence of choroidal vascular hyperpermeability (CVH) (P = .013), and subretinal fluid (P = .044) at baseline in eyes with PCV. Although poorer BCVA and the presence of subretinal fluid predicted larger gains in BCVA in both subtypes treated with aflibercept, eyes with typical neovascular AMD had greater improvement if no pigment epithelial detachment was present, while eyes with PCV had greater improvement if CVH was present.

AREDS simplified severity scale as a predictive factor for response to aflibercept therapy for typical neovascular age-related macular degeneration.

To investigate whether the severity of the condition in the untreated fellow eye is a predictive factor for the response to intravitreal aflibercept injection (IAI) for exudative age-related macular degeneration (AMD). A retrospective medical chart review was conducted for 88 patients with treatment-naïve neovascular AMD, who were initially treated with three monthly IAIs, followed by monthly monitoring and re-injection as needed for at least 12months. Subjects were classified into three groups according to the severity of the condition in their untreated eye, based on the severity scale in the Age-Related Eye Disease Study (AREDS): group 0, AREDS severity level 1 (no drusen); group 1, AREDS severity level 2 or 3 (any drusen); group 2, AREDS severity level 4 (advanced AMD). Genotyping was performed in all cases for ARMS2 A69S and CFH I62V. Fellow-eye severity was associated with age and the risk variant of ARMS2 A69S (P = 0.005 and 0.001, respectively). Although best-corrected visual acuity (BCVA) had improved significantly after 12months in all groups, this improvement was significantly greater in group 0 than in the other groups (P = 0.008). The retreatment-free period was also significantly longer for group 0 than for the other groups (P = 0.016), and the number of additional injections was significantly associated with fellow-eye severity (P = 0.007). Fellow-eye severity was associated with treatment response in terms of visual improvement and retreatment and may be a predictive factor for response to IAI for neovascular AMD.

RISK FACTORS AND CLINICAL SIGNIFICANCE OF PRECHOROIDAL CLEFT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

To investigate the risk factors associated with prechoroidal cleft occurrence after treatment for neovascular age-related macular degeneration (nAMD) and to elucidate its clinical significance. Two hundred thirty-four subjects who were treated for neovascular age-related macular degeneration were assessed to identify prechoroidal cleft on optical coherence tomography. Clinical variables were compared between patients manifesting a cleft (cleft group) and patients who did not (control group). Prechoroidal cleft was detected in 29 of 234 patients (8.1%). Although the baseline visual acuity was not different between the 2 groups, logMAR visual acuity at final visit was 0.89 ± 0.74 (with approximate Snellen equivalent of 20/160) in the cleft group and 0.65 ± 0.69 (with approximate Snellen equivalent of 20/100) in controls (P < 0.05). Within cleft group, the early-onset (<6 months) subgroup had even worse visual outcomes than the late-onset subgroup (P < 0.05). Multiple logistic regression analyses revealed that the incidence of prechoroidal cleft was positively correlated with having received intravitreal gas injection to displace a submacular hemorrhage and a diagnosis of retinal angiomatous proliferation and typical neovascular age-related macular degeneration (P < 0.05). Diagnosis of retinal angiomatous proliferation and typical neovascular age-related macular degeneration, and a submacular hemorrhage treated by pneumatic displacement were the independent risk factors for development of prechoroidal cleft. Eyes with a cleft, especially clefts that develop early, generally had worse prognoses than eyes without clefts.

Shared genetic variants for polypoidal choroidal vasculopathy and typical neovascular age-related macular degeneration in East Asians.

Polypoidal choroidal vasculopathy (PCV), a subtype of age-related macular degeneration (AMD) more frequently seen in East Asians, has both common and distinct clinical manifestations with typical neovascular AMD (tAMD). We aim to examine the extent to which common genetic variants are shared between these two subtypes. We performed the meta-analysis of association in a total of 1062 PCV patients, 1157 tAMD patients and 5275 controls of East Asian descent from the Genetics of AMD in Asians Consortium at the 34 known AMD loci. A total of eight loci were significantly associated with PCV, including age-related maculopathy susceptibility 2 (ARMS2)-HtrA serine peptidase 1 (HTRA1), complement factor H (CFH), C2-CFB-SKIV2L, CETP, VEGFA, ADAMTS9-AS2 and TGFBR1 (P<5 × 10-4) from the single-nucleotide polymorphism-based test and COL4A3 from the gene-based tests (Pgene=2.02 × 10-4). PCV and tAMD are genetically highly correlated (rg=0.69, P=4.68 × 10-3), with AMD known loci accounting for up to 36% variation. Weaker association for PCV was observed at ARMS2-HTRA1 (Pdif=4.39 × 10-4) and KMT2E-SRPK2(Pdif=4.43 × 10-3), compared with tAMD. Variants at CFH, CETP and VEGFA exhibited different association signals in East Asians, in contrast to those in European individuals. Our data suggest a substantially shared genetic susceptibility for PCV and tAMD, while also highlight the unique associations for PCV, which is useful in understanding the pathogenesis of PCV.

Comparison of pro re nata versus Bimonthly Injection of Intravitreal Aflibercept for Typical Neovascular Age-Related Macular Degeneration

Purpose: The aim of this study was to clarify the 1-year outcomes of pro re nata (PRN) and bimonthly intravitreal injections of aflibercept (IVA) for typical neovascular age-related macular degeneration (tAMD) after the initial 3 monthly IVA. Methods: We conducted a prospective, interventional study. Fifty-eight treatment-naïve patients with tAMD were randomly assigned to the PRN (30 patients) or the bimonthly (28 patients) treatment group. Both groups initially received 3 monthly IVA. Visual acuity, central macular retinal thickness (CRT), and central choroidal thickness (CCT) were evaluated at 12 months. Subanalysis was performed to identify factors associated with the best-corrected visual acuity (BCVA). Results: BCVA was significantly improved only in the bimonthly group at 12 months. CRT and CCT were significantly decreased in both groups. Subanalysis showed that the only factor associated with BCVA improvement at 12 months was the existence of pigment epithelial detachment at baseline. Conclusions: BCVA showed significant improvement only in the bimonthly group but not in the PRN group at 12 months.

Incidence and Timing of the First Recurrence in Neovascular Age-Related Macular Degeneration: Comparison Between Ranibizumab and Aflibercept

To compare the incidence and timing of first recurrence between patients who were treated with ranibizumab and aflibercept in neovascular age-related macular degeneration (AMD). This retrospective study included 120 patients who received the diagnosis of treatment-naive typical neovascular AMD or polypoidal choroidal vasculopathy (PCV) and were treated using either ranibizumab (n = 73) or aflibercept (n = 47). Recurrence within 10 months of the third injection was compared between the 2 treatment groups. In all 120 patients, there was no difference in recurrence between the ranibizumab and the aflibecept groups (P = 0.846). One hundred five patients completed 12 months follow-up. In typical neovascular AMD, disease recurred in 69.6% (16/23) of patients in the ranibizumab group, with a mean period of 4.4 ± 1.8 months after the third injection. In the aflibercept group, the equivalent values were 68.8% (11/16) and 4.5 ± 1.4 months. In PCV, disease recurred in 72.5% (29/40) of patients in the ranibizumab group, with a mean period of 3.8 ± 1.7 months after the third injection. In the aflibercept group, the equivalent values were 69.2% (18/26) and 4.3 ± 2.0 months. Although the incidence of recurrence was slightly higher and the duration between the third injection and the first recurrence was slightly shorter in patients treated using ranibizumab, the differences were not significant. Our results require confirmation in further studies.

Incidence and risk factors of retreatment after three-monthly aflibercept therapy for exudative age-related macular degeneration

Though anti-vascular endothelial growth factor therapy has become the standard treatment for exudative age-related macular degeneration (AMD), retreatment after the initial loading injection is inevitable in most eyes with residual or recurrent exudative changes. In the present study, we studied 140 treatment naïve eyes with typical neovascular AMD (n = 71) or polypoidal choroidal vasculopathy (PCV) (n = 69) and investigated the incidence and risk factors of retreatment after 3-monthly intravitreal aflibercept injection for exudative AMD during the 12-month period. At 12 months, best-corrected visual acuity (BCVA) improved significantly from 0.45 ± 0.39 to 0.26 ± 0.33 (P = 4.1 × 10−11). Multiple regression analysis revealed that better baseline BCVA (P = 3.6 × 10−14) and thicker subfoveal choroidal thickness (P = 0.039) were associated with better BCVA at 12-months. Retreatment was required in 94 out of 140 (67.1%) eyes. Multivariate logistic regression analysis revealed that older age (P = 7.2 × 10−3) and T-allele of ARMS2 A69S (rs10490924) variants (P = 1.9 × 10−3) were associated with retreatment. Cox-regression analysis revealed that older age (P = 1.0 × 10−2) and T-allele of the ARMS2 gene (P = 6.0 × 10−3) were associated with retreatment-free period. The number of retreatment episodes was significantly different among the ARMS2 genotypes (P = 8.1 × 10−4). These findings might be helpful for physicians when considering the optimal treatment regimen for exudative AMD.

Three-Dimensional Analysis of Morphologic Changes and Visual Outcomes in Neovascular Age-Related Macular Degeneration.

To investigate the association of three-dimensionally quantified lesions with best-corrected visual acuity (BCVA) in typical neovascular age-related macular degeneration (nAMD). We retrospectively analyzed 65 eyes of 61 typical nAMD patients. Lesions at baseline and month 12 were manually delineated in optical coherence tomography. The volume of intraretinal fluid (IRF), subretinal fluid (SRF), subretinal hyperreflective material (SHRM), and pigment epithelial detachment (PED) were measured. In addition, the areas of external limiting membrane (ELM) and ellipsoid zone (EZ) were calculated. At baseline, poor baseline BCVA was associated with increased volume of IRF and SHRM and impaired area of ELM (β = 0.34, P = 0.001; β = 0.46, P < 0.001; and β = -0.23, P = 0.03, respectively). At month 12, poor BCVA was associated with increased volume of IRF, reduced intact ELM area, and decreased EZ area (β = 0.24, P = 0.01; β = -0.30, P = 0.02; and β = -0.37, P = 0.004, respectively). Baseline BCVA, volume of IRF, and intact area of ELM were significant predictors for BCVA at month 12 (β = 0.29, P = 0.01; β = 0.30, P = 0.01; and β = -0.28, P = 0.01). Changes of BCVA were associated with changes of SHRM volume, intact EZ area, and ELM area (β = 0.35, P = 0.002; β = -0.28, P = 0.01; and β = -0.22, P = 0.048, respectively). The predictive power of volumetric analysis was higher than that of qualitative analysis (R2 = 0.47 vs. R2 = 0.37). The volume of SRF and fibrovascular PED showed positive and negative effect on visual outcome each, but they were not strong enough to remain in multivariate model. Best-corrected visual acuity could be explained by three-dimensional optical coherence tomography morphology to a fair degree. In addition, three-dimensional analysis could predict visual outcomes better than qualitative analysis.

The impact of typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy on vision-related quality of life in Asian patients

AimsTo determine the impact of neovascular age-related macular degeneration (nAMD) on vision-related quality of life (VRQoL) in an Asian population.MethodsIn this cross-sectional study, 162 subjects with nAMD from the Asian...

DIAGNOSIS OF TYPE 3 NEOVASCULARIZATION BASED ON OPTICAL COHERENCE TOMOGRAPHY IMAGES.

To evaluate the concordance of an optical coherence tomography (OCT)-based diagnosis of Type 3 neovascularization and an indocyanine green angiography (ICGA)-based diagnosis in neovascular age-related macular degeneration (AMD). This observational case series includes 263 eyes from 263 patients who were diagnosed with treatment-naive neovascular AMD. Patients exhibiting at least three of the following OCT features were diagnosed with Type 3 neovascularization: subfoveal choroidal thickness <200 μm, presence of intraretinal fluid accumulation, absence of subretinal fluid, gently-sloping dome-shaped retinal pigment epithelial detachment or trapezoid-shaped retinal pigment epithelial detachment without an obvious peak, and intraretinal mass lesion. The incidence of cases exhibiting three or more OCT features was compared among different subtypes of neovascular AMD. Additionally, the concordance of OCT-based diagnosis and ICGA-based diagnosis was evaluated. Three or more OCT features were noted in 8 of 82 (9.8%) eyes with typical neovascular AMD, 4 of 147 (2.7%) eyes with polypoidal choroidal vasculopathy, and 30 of 34 (88.2%) eyes with Type 3 neovascularization, respectively. The incidence was significantly greater in Type 3 neovascularization than in the other subtypes of neovascular AMD (P < 0.001). Of patients diagnosed with Type 3 neovascularization using ICGA-based methods, 88.2% were also diagnosed with Type 3 neovascularization using OCT-based methods. Only 5.2% of patients diagnosed with other subtypes of neovascular AMD using ICGA-based methods were diagnosed with Type 3 neovascularization using OCT-based methods. Optical coherence tomography-based diagnosis of Type 3 neovascularization showed relatively high concordance compared with ICGA-based diagnosis. This method may be useful in clinical practice.