Abstract
Purpose :
Pachychoroid neovasculopathy (PNV) have been recently noticed as a new clinical entity. On the other hand, PNV could not be a completely independent entity from the previous neovascular age-related macular degeneration (AMD) types, such as typical AMD, polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP), but some of each type might be determined to be PNV. In the current study, we retrospectively reviewed the clinical records of AMD patients and re-classified the AMDs to determine the prevalence of PNV.
Methods :
One hundred and ten eyes of 100 consecutive patients diagnosed previously with AMD at Tokyo Women’s Medical University Hospital were studied. All patients were Japanese over 50 years old, and the mean age was 75.6 years (72 males and 28 females). PNV was defined with macular neovascularization (MNV) detected just above the dilated choroidal vessels (Pachy-vessels), and choroidal thickness was not included in the definition. Locations of choroidal vessels, horizontal symmetric vortex vein, and watershed zone were evaluated on indocyanine green angiography (IA, HRA2, Heidelberg) and/or en face optical coherence tomography (OCT, Elite 9000, Zeiss). When polypoidal lesion was identified in IA, it was determined to be PCV. Subfoveal choroidal thickness (SCT) was also manually measured on OCT.
Results :
Based on the current criteria, twenty-six patients (26.0%, 26 eyes) were diagnosed with PNV, 38 patients (38.0%, 44 eyes) with PCV, 29 patients (29.0%, 31 eyes) with typical AMD, and 7 patients (7.0%, 10 eyes) with RAP. All PNV cases (26 patients) diagnosed as typical AMD on the previous criteria. Asymmetric vortex vein and watershed zone shift were observed in 80.8% of PNV cases, which was significantly higher than in 40.0% of non-PNV cases (P<0.01). There was no significant difference in mean SCT between PNV and non-PNV cases (277±88μm vs 252±95μm, P=0.21).
Conclusions :
According to our criteria, including the new entity of PNV, which excludes choroidal thickness as diagnostic index, PNV was identified in 26% of neovascular AMD in Japanese patients. The results of this study may have a significant impact on the treatment strategy for Japanese patients with MNV.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.