Abstract
Purpose :
Type 1 CNV is associated with a late hyperfluorescent plaque (LPHP) that does not increase with time, seen on ICGA (indocyanine angiography). Missing in literature to date, this study evaluates the frequency of LPHP in type 1 CNV in CSCR and AMD and its prognostic value in visual acuity and response to anti-VEGF.
Methods :
We retrospectively reviewed the images and medical records of patients from Jules Gonin Eye Hospital in Lausanne, Ophtalmopole Hopital Cochin and Centre Ophtalmologique de l’Odéon in Paris between 2012 and 2021. Inclusion criteria were: type 1 CNV secondary to CSCR and AMD, late ICG cliché (>20mins) and visualisation of CNV on OCTA. Quantitative and qualitative parameters on OCT and best corrected visual acuity were recorded at baseline and after 3 monthly VEGF injections.
Results :
83 eyes of 83 patients were included in the study 35 with CSCR and 48 with AMD. Compared to the AMD group, patients in the CSCR group were younger (61.3 ± 10.4 vs. 80.2 ± 6.8 years, p<0,001), predominantly male (68,6% vs 35,4%; p=0,003) and with a thicker choroid (379 ± 93,3 4 vs 204,2 ± 93,2μm; p<0,001). Type 1 CNV in CSCR showed significantly less LPHP (31,4%) compared to eyes with AMD (77,1%; p<0,001). Patients with LPHP at baseline (n=48) were older (76,1 ± 10,8 years vs. 67 ± 13,2, p=0,002), had a worse baseline BCVA (0,37 ± 0,22 vs 0,27 ± 0,28 LogMAR, p=0,03), compared to eyes without LPHP (n=35). SFCT was higher in the CSCR subgroup (n=35) for eyes with LPHP (n=11) compared to eyes without LPHP (n=24) (434 ± 92,2 vs 346,1 ± 86,4μm respectively; p=0,006). BCVA at baseline did not differ significantly between CNV in CSCR or AMD (0.29 ± 0.28 vs. 0.36 ± 0.23 Logmar, p=0,14). Eyes without LPHP had a significant better BCVA than eyes with LPHP (0,37 ± 0,22 vs 0,27 ± 0,28 LogMAR, p=0,03).
Conclusions :
LPHP was significantly less present in chronic CSCR complicated by CNV than in AMD. BCVA was higher in eyes without LPHP at baseline. This shows that leakage of macromolecules from CNV and its accumulation in the RPE imaged by the LPHP differs in eyes with CSCR and AMD. LPHP associated with worse BCVA at baseline in both diseases might suggest a suffering of the RPE. LPHP should not only be considered as a hallmark for choroidal neovascularization but also a sign of RPE dysfunction. Its long-term prognostic value still remains to be explored in larger cohorts.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.