Massive choroidal neovascular membranes: a severe bilateral phenotype of refractory neovascular age-related macular degeneration

Abstract

Purpose : Disciform scarring typically represents the quiescent end-stage findings of advanced age-related macular degeneration (AMD); however, very rarely, a small subset of patients can have repeated re-activation of these lesions with extension beyond the arcades to the equator, which is associated with profound vision loss. The aim of the study was to characterize this uniquely severe phenotype of neovascular AMD.

Methods : The study is a retrospective case series of patients from 2004 to 2015 with the presence of a massive disciform scars encompassing the posterior pole and extending to the equator. Demographic data, Snellen visual acuity (VA), past ocular and medical history, fluorescein angiography, and treatment regimen were reviewed.

Results : Fourteen eyes of 8 patients were identified that met inclusion criteria. Final visual acuities for included eyes were 20/400 (n = 1), Count Fingers (n = 5), Hand Motion (n = 5), No Light Perception (n = 3). Of the 10 eyes with well-documented lesion reactivation, subretinal hemorrhage at the border of the lesion was the sign of reactivation in all eyes (100%) prior to lesion expansion. 10/14 eyes (71.4%) underwent intravitreal anti-VEGF therapy (1-43 injections), 3/14 (21.4%) underwent intravitreal corticosteroid injections (1-11 injections), and 3/14 eyes underwent photodynamic therapy (PDT) (1-5 sessions); none were able to halt the progression. The massive lesions were bilateral in 6 of 8 patients; the lesions, however, developed asymmetrically and there was a mean of 64 months prior to contralateral involvement.

Conclusions : Massive choroidal neovascular membranes that extend to the equator are a rare phenotype of neovascular AMD. The finding is often bilateral, and invariably causes profound visual loss. Progression was noted to occur as relentless reactivation of the border of disciform lesions.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.