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Jin Yang, Qinqin Zhang, Elie Motulsky, Marie Thulliez, Yingying Shi, Cancan Lyu, Luis De Sisternes, Mary K Durbin, William Feuer, Ruikang K Wang, Giovanni Gregori, Philip J. Rosenfeld; Two-Year Natural History of Subclinical Neovascularization in Non-Exduative Age-Related Macular Degeneration using Swept Source OCT Angiography. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4221.
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© ARVO (1962-2015); The Authors (2016-present)
Swept source optical coherence tomography angiography (SS-OCTA) was used to study the prevalence, incidence, and natural history of subclinical macular neovascularization (MNV) in eyes with unilateral non-exudative age-related macular degeneration (AMD).
All patients were imaged using 3x3 mm and 6x6 mm SS-OCTA scan patterns (PLEX Elite 9000; Carl Zeiss Meditec, Inc, Dublin, CA). MNV was detected using an en face slab with boundaries extending from the outer retina to the choriocapillaris. The size of the subclinical MNV was measured. Prevalence and incidence of subclinical MNV, the risk of exudation with Kaplan-Meier cumulative estimates through 2 years, and the association between neovascular lesion size and the risk of exudation were assessed.
From August 2014 through March 2018, 227 patients underwent SS-OCTA imaging with 154 eyes diagnosed with intermediate AMD and 73 eyes with late AMD characterized by geographic atrophy (GA). When first imaged with SS-OCTA, a total of 30 eyes had subclinical MNV for a prevalence of 13.2%. During follow-up, 12 eyes developed subclinical MNV for an incidence rate of 8.9%. Exudation occurred in 19 of 191 eyes during follow-up, and of these 19 eyes, 14 eyes had pre-existing subclinical MNV. By 24 months, the Kaplan Meier cumulative incidence of exudation for all eyes was 11.4%. For eyes with subclinical MNV, the incidence of exudation was 34.5% and for eyes without subclinical MNV, the incidence was 6.3%. This difference corresponded to a 13.6-fold increased risk of exudation (95% CI: 4.9-37.7) for eyes with subclinical MNV. There was no significant risk of exudation based on lesion size alone (P=0.91).
By 24 months, the risk of exudation was 13.6-fold greater for eyes with subclinical MNV detected by SS-OCTA compared with eyes without detectable MNV. The size of the neovascular lesion did not correspond to the onset of exudation. We continue to recommend close follow-up and home monitoring of these eyes with subclinical MNV, and treatment is not recommended in the absence of exudation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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