A total of 382 eyes of 382 patients met all eligibility criteria. Ultimately, 97, 163, 37, and 85 eyes were diagnosed with typical exudative AMD, PCV, RAP, and myopic CNV, respectively. Among the 382 eyes, choroidal vascular hyperpermeability and punctate hyperfluorescent spots were noted in 56 (14.7%) and 168 eyes (43.9%), respectively. Among the 168 eyes with punctate hyperfluorescent spots, 89 (52.9%) and 79 eyes (47.0%) were classified as having solitary and clustered spots, respectively. Fifty-five of 56 eyes (98.2%) with choroidal vascular hyperpermeability also had punctate hyperfluorescent spots. Initial agreement between the two examiners for evaluating the presence of punctate hyperfluorescence spots was achieved in 354 of 382 eyes (92.7%). The presence of these spots in the remaining 28 eyes was determined by discussion between the two examiners. Initial agreement for evaluating the presence of choroidal vascular hyperpermeability was achieved in 329 of 382 eyes (86.1%).
Table 1 summarizes the prevalence of choroidal vascular hyperpermeability and punctate hyperfluorescent spots in eyes with each CNV subtype. Among eyes with typical exudative AMD and PCV, choroidal vascular hyperpermeability was noted in 12 eyes (12.4%) and 44 eyes (26.9%), respectively. Choroidal vascular hyperpermeability was not observed in any eye with RAP or myopic CNV. The prevalence of choroidal vascular hyperpermeability was significantly different among the four CNV subtype groups (
P < 0.001). Punctate hyperfluorescent spots were noted in 42 eyes (43.3%) with typical exudative AMD, 118 eyes (72.4%) with PCV, 4 eyes (10.8%) with RAP, and 4 eyes (4.7%) with myopic CNV. The prevalence was significantly different among the four CNV subtype groups (
P < 0.001). In the 168 eyes with punctate hyperfluorescent spots, a clustered pattern was noted in 12 eyes (28.6%) with typical exudative AMD, 66 eyes (55.9%) with PCV, and 1 eye (25.0%) with RAP. Clustered spots were not observed in any eye with myopic CNV. Differences among the four CNV subtype groups in spot subtype prevalence (solitary versus clustered) were statistically significant (
Table 2,
P = 0.001).
A total of 55 eyes had both punctate hyperfluorescent spots and choroidal vascular hyperpermeability. Of these, solitary and clustered pattern punctate hyperfluorescent spots were observed in 15 (27.3%) and 40 eyes (72.7%), respectively. In the other 113 eyes with punctate hyperfluorescent spots, but no choroidal vascular hyperpermeability, solitary, and clustered punctate hyperfluorescent spots were observed in 74 (65.5%) and 39 eyes (34.5%), respectively. The prevalence of clustered-pattern punctate hyperfluorescent spots was higher in eyes with choroidal vascular hyperpermeability than in eyes without it (
Table 3,
P < 0.001).
Table 4 shows the difference in punctate hyperfluorescent spot incidence between eyes with and without choroidal vascular hyperpermeability in typical exudative AMD and PCV. In eyes with typical exudative AMD, all 12 eyes (100%) with choroidal vascular hyperpermeability also had punctate hyperfluorescent spots. However, only 30 of 85 eyes (35.3%) without choroidal vascular hyperpermeability had punctate hyperfluorescent spots. This large difference was statistically significant (
P < 0.001). In eyes with PCV, punctate hyperfluorescent spots were observed in 43 of 44 eyes (97.7%) with choroidal vascular hyperpermeability and in 75 of 119 eyes (63.0%) without choroidal vascular hyperpermeability. This difference was statistically significant (
P < 0.001).
A total of 56 eyes had choroidal vascular hyperpermeability, of which 49 eyes (87.5%) had enhanced-depth imaging OCT images available. Mean subfoveal choroidal thickness was 389.5 ± 121.1 μm in these 49 eyes. Subfoveal choroidal thickness was less than 200 μm in four eyes (one eye with typical exudative AMD, three eyes with PCV), between 200 and 400 μm in 21 eyes (4 eyes with typical exudative AMD, 17 eyes with PCVs), and greater than 400 μm in 24 eyes (4 eyes with typical exudative AMD, 20 eyes with PCVs,
Fig. 2A). Of the 168 eyes with punctate hyperfluorescent spots, enhanced-depth imaging OCT images were available in 154 eyes (91.7%). Mean subfoveal choroidal thickness was 318.6 ± 127.4 μm in these 154 eyes. Subfoveal choroidal thickness was less than 200 μm in 30 eyes (10 eyes with typical exudative AMD, 16 eyes with PCV, 3 eyes with RAP, 1 eye with myopic CNV), between 200 and 400 μm in 79 eyes (16 eyes with typical exudative AMD, 59 eyes with PCV, 1 eye with RAP, 3 eyes with myopic CNV), and greater than 400 μm in 45 eyes (9 eyes with typical exudative AMD, 36 eyes with PCV,
Fig. 2B). The difference in subfoveal choroidal thickness between eyes in the solitary pattern group (314.5 ± 127.0 μm,
n = 80) and eyes in the clustered pattern group (322.9 ± 128.5 μm,
n = 74) was not significant (
P = 0.682). Among the 326 eyes without choroidal vascular hyperpermeability, 284 eyes (87.1%) had enhanced-depth imaging OCT images available. The mean subfoveal choroidal thickness in these 284 eyes was 215.3 ± 123.9 μm. Among the 214 eyes without punctate hyperfluorescent spot, 179 eyes (83.6%) had enhanced-depth imaging OCT images available. The mean subfoveal choroidal thickness in these 179 eyes was 174.2 ± 108.9 μm.
Seventy-eight of the 297 eyes (26.3%) with exudative AMD had available ICGA images obtained 3 months after initiating intravitreal ranibizumab therapy (Lucentis; Genentech, Inc., South San Francisco, CA, USA). All 78 eyes had received three injections, 1 month apart, during the 3-month period. Neither new development nor resolution of choroidal vascular hyperpermeability or punctate hyperfluorescent spots was observed in any of these eyes.