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Natalia Camacho, Giulio Barteselli, Lingyun Cheng, Dirk-Uwe G Bartsch, William R Freeman; Hyper-Autofluorescent Ring in Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3398.
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To characterize the presence of a hyper-autofluorescent ring (HAR) associated with choroidal neovascularization (CNV) complex in patients undergoing anti-VEGF therapy for wet age-related macular degeneration (AMD).
We reviewed spectral-Domain OCT (SD-OCT) and fundus auto-fluorescence (FAF) images on the Heidelberg Spectralis from all patients with wet AMD seen at the Jacobs Retina Center UCSD. The presence, size and pattern of hyper-autofluorescence associated with CNV complex was evaluated at varying times after initiation of anti-VEGF therapy, which was used every four weeks for Bevacizumab or Ranibizumab and every eight weeks for Aflibercept until all intra-retinal and sub-retinal fluid (SRF) was resolved. A subgroup of treatment naïve patients with new onset CNV was studied to carefully analyze the relationship between pre-treatment imaging characteristics and presence of a HAR. We evaluated the correspondence of the HAR on FAF with the SRF seen on OCT prior to treatment.
The study included 362 eyes of 248 wet AMD patients with mean age of 79 years (range 49-97). The presence of a HAR was found in 138 eyes (38%). A subgroup of treatment-naïve patients included 64 eyes of 58 patients with mean age of 78 years (range 65-92). Twenty-five eyes (39%) showed a HAR on FAF; 23 of these (92%) had SRF on baseline OCT. The HAR developed over the course of treatment in 15 eyes; in the remaining 10 eyes it was present at baseline, suggesting it is related to fluid or fluid duration and not treatment itself. We compared the baseline SRF on OCT scans, using built-in calipers, with the hyper-autofluorescent area seen on subsequent FAF images and found a close correspondence of their borders and extent. The HAR presence was significantly associated with mean area of SRF [<p=0.0013] but not with baseline mean lesion area [<p=0.4]. All patients had persistence of HAR throughout the observation period to the present time (up to 6 years) suggesting ongoing stress or changes of retinal pigment epithelium (RPE) in the area of SRF associated with the initial CNV membrane.
The presence of a HAR on FAF was found in nearly 40% of patients with wet AMD. In patients with new-onset CNV and no previous treatment, the HAR corresponded well to the area of SRF on initial OCT and was found as early as baseline and as long as 18 months, persisting for years after the initial diagnosis. This positive association indicates continuous stress on the RPE after exposure to prolonged SRF.
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