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Sharmin Badiei, Nishal Patel, Susan Walker; Clinical Features Of Self-resolving Sub-foveal Choroidal Neovascularisation in ‘Wet’ Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6526.
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Choroidal neovascularisation (CNV) in AMD results in rapid painless loss of central vision in the affected eyes and with Anti-VEGF intra-vitreal therapy results in stabilization or improvement in a vast majority of patients. We describe 10 patients in whom mild early active disease was monitored and untreated with spontaneous consequent disease resolution
A 1 year observational non-interventional retrospective case series review of electronic records and imaging data. A description of the clinical features of 10 eyes of 10 patients with early active CNV who presented with symptomatic history of mild central distortion, diagnosed with active early choroidal neovascularisation on OCT and Fluorescein Angiography
The average age of affected patients was 76.2 years with presenting mean vision of 0.132 logMAR (20/27.1 Snellen equivalent). OCT examination demonstrated sub-retinal fluid in all patients (100%), 20% (2/10) had intra-retinal fluid and 100% were found to have Retinal Pigment Epithelial disturbance with intact external limiting membrane with mild sub-foveal occult CNV on angiography. OCT retinal thickness (CRT) improved marginally from a mean of 227.6 to 222 microns. At 12 months, the mean vision improved to LogMAR 0.032 (20/21.5 Snellen Equivalent) in absence of treatment intervention with resolution of sub-retinal fluid (80%).
The implementation of rapid access pathways and better treatments for patients with Wet AMD within the NHS specifically those with progressive vision loss has resulted in an improved screening process. However, patients with early mild active disease and excellent presenting vision may resolve spontaneously without the need for immediate injection therapy. We therefore recommend monitoring at a 4-6 weekly interval initially to observe for progression with follow-up extended upto 3 months in stable lesions if progression is not evident
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