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Bishwanath Pal, Filipa Rodrigues, Hagar Khalid; A new phenotype of atypical wet age-related macular degeneration . Invest. Ophthalmol. Vis. Sci. 2019;60(9):129.
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To describe a possible new phenotype of atypical wet age-related macular degeneration (AMD), with a similar pattern of OCT and autofluorescence (AF) findings and dependency on frequent intravitreal anti-VEGF injections.
Retrospective case series of 3 patients with bilateral atypical wet AMD under the care of Moorfields Eye Hospital. Demographic data, initial and final best corrected visual acuity (BCVA) and number and type of intravitreal injections were collected. Spectral-domain OCT (SD-OCT), blue laser AF (BAF), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed.
All patients presented with bilateral visual distortion and symmetrical cystic intraretinal fluid (IRF) and shallow subretinal fluid (SRF) on SD-OCT. FFA showed leakage consistent with choroidal neovascular (CNV) membrane. In 1 patient, the leakage was peripapillary. ICGA excluded polyps. BAF imaging showed a similar symmetrical pattern of mottled hypo and hyperautofluorescence. In 2 patients, the BAF changes were macular, while in a third patient they were localized at the peripapillary region. The first patient, a 58 year old female, underwent 8 ranibizumab and 10 aflibercept injections in the right eye (OD) and 10 ranibizumab plus 12 aflibercept injections in the left eye (OS), over the course of 45 months. Macular dystrophy was excluded. The second patient was a 73 year old male with symmetrical findings at baseline, who received 16 ranibizumab and 20 aflibercept OS injections for 9 years. Interestingly, the OD only needed two initial ranibizumab injections. Finally, we present a 88 year old male with peripapillary CNV who underwent 37 and 34 ranibizumab injections in the OD and OS, as well as 3 bilateral aflibercept injections over almost 7 years. The final BCVA was at least 20/40 for both eyes in the first 2 patients. The third patient has bilateral cataracts and macular atrophy, with a final BCVA of 20/125 in the OD and 20/200 in the OS.
All these 3 patients with atypical wet-AMD had similar mottled hypo and hyperautofluorescence on BAF and symmetrical OCT morphology, with improvement of IRF and SRF with anti-VEGF injections. However, it has not been possible to stop the treatment over several months, except in one eye. We suggest this may consist of a new phenotype of atypical wet-AMD with good response, however dependency, on anti-VEGF intravitreal injections.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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