Purchase this article with an account.
Tiezhu Lin, Kunny C Dans, Amit Meshi, Manuel Amador, William R Freeman; AMD associated Peripapillary Choroidal Neovascularization in the era of anti-VEGF therapy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):802.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To characterize the natural history and response of peripapillary choroidal neovascularization (PPCNV) in wet age-related macular degeneration (AMD) to anti-VEGF therapy.
Eyes with wet AMD and PPCNV were retrospectively reviewed. PPCNV resulting from ocular pathology other than wet AMD were excluded. Eyes were divided into observation and treatment groups. All eyes underwent complete ophthalmologic examination and diagnosis was confirmed by fluorescein angiography (FA), and macular and peripapillary optical coherence tomography (OCT). Eyes with PPCNV resulting in sub- or intraretinal macular fluid were treated with anti-VEGF monotherapy as needed every 4 weeks. Eyes were monitored with FA, OCT and best-corrected visual acuity measurement using ETDRS charts.
Thirty-three eyes of 27 patients were included. The median age was 82 years (range 62-94). The median duration of follow-up was 69 (range 6-165) and 34 (range 10-83) months for the observation and treatment groups, respectively. Ten (30%) of the 33 eyes without initial macular fluid never developed it and required no treatment during the entire course of follow up. Kaplan Meier survival analysis showed that for all eyes presenting with PPCNV without macular fluid, the median time to require treatment was 16 months. For eyes requiring treatment, the median number of injections required until complete fluid absorption was 3 and the median time to recurrence was 6 months (range 3-52). The median BCVA was 20/50 at initiation of treatment and 20/32 when the macula was dry, a 2.5 line increase (p=0.0002).
Our cohort suggests that in AMD, PPCNV is a more benign disease than submacular CNV. Peripapillary fluid progression to involve the macular is slow and the disease responds rapidly to anti-VEGF treatment. PPCNV is different than macular CNV because it may not require treatment for many months or years if not involving the fovea. In comparison to typical AMD with central CNV, macular fluid in PPCNV dries after a similar number of injections (3 versus 4 injections based on Clin Ophthalmol. 2012;6:1149-57), and recurrence occurs after a similar duration of observation (6 versus 5.5 months based on Clin Exp Ophthalmol. 2011;249(5):645-52).
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Kaplan-Meier survial curves for the recurrence time (A) and the number of injection needed (B) in the 1st treatment cycle.
Kaplan-Meier survial curve for the time to treatment.
This PDF is available to Subscribers Only