June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
The RAP study, Report 8: Does choroidal neovascularization contribute to the pathogenesis of macular neovascularization type 3?
Author Affiliations & Notes
  • Bilal Haj Najeeb
    Eye Department, Medical University of Vienna, Vienna, Austria
  • Guenther Weigert
    Eye Department, Medical University of Vienna, Vienna, Austria
  • Wolf Bühl
    Eye Department, Medical University of Vienna, Vienna, Austria
  • Stefan Sacu
    Eye Department, Medical University of Vienna, Vienna, Austria
  • Ursula Schmidt-Erfurth
    Eye Department, Medical University of Vienna, Vienna, Austria
  • Footnotes
    Commercial Relationships   Bilal Haj Najeeb Retinsight, Code E (Employment); Guenther Weigert None; Wolf Bühl None; Stefan Sacu None; Ursula Schmidt-Erfurth Apellis, Code C (Consultant/Contractor), Genentech, Code F (Financial Support), Kodiak, Code F (Financial Support), Novartis, Code F (Financial Support), Apellis, Code F (Financial Support), Retinsight, Code F (Financial Support), Retinsight, Code P (Patent)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 2203. doi:
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      Bilal Haj Najeeb, Guenther Weigert, Wolf Bühl, Stefan Sacu, Ursula Schmidt-Erfurth; The RAP study, Report 8: Does choroidal neovascularization contribute to the pathogenesis of macular neovascularization type 3?. Invest. Ophthalmol. Vis. Sci. 2023;64(8):2203.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Choroidal neovascularization (CNV) is a late event in the pathogenesis of macular neovascularization type 3 (MNV3) according to the staging system proposed by Yannuzzi. Therefore, in this study we want to describe the origin and route of the neovessels in eyes with long-standing MNV3 using advanced diagnostic methods.

Methods : Patients with retinal-choroidal anastomosis (RCA) secondary to MNV3 were included in this prospective study. Multimodal imaging including color photography, fluorescein and indocyanine angiography and optical coherence tomography angiography (OCTA) with extended depth imaging was used to explore the route of RCA and neovessels. Specifically, 3x3 mm OCTA images were acquired to investigate the retinal and choroidal origin of the neovascularization and the integrity of the choroidal vasculature in the central macula. Furthermore, oxygen saturation of RCA was measured using retinal oximeter (Oxymap T1). Five eyes with fibrosis and CNV secondary to MNV 1 or 2 were also included as a control group.

Results : Nineteen arteriolar and venular RCAs in 13 eyes of 10 patients (9 female, 1 male) were evaluated in the study group. Three eyes were treatment-naïve and 10 were pretreated with anti-angiogenic therapy. The subretinal downgrowth of RCA and emerging retinal neovascularization occurred only within the hyperreflective fibrotic tissue. RCA tended to make a relatively long route, loops and bifurcations within the fibrotic tissue before it ended at a big choroidal vessel. Severe damage of the choroidal vessels involving all three layers was observed. The oxygen saturation in the arteriolar RCAs was as high as in the peripapillary arterioles. No CNV within the fibrotic tissue could be identified in the study group.

Conclusions : Fibrotic tissue seems to be an essential requirement for the downgrowth of RCA and retinal neovascularization in MNV3. The long route and high oxygen saturation of RCA may aim to compensate for the impaired choroidal supply of the remaining outer retinal layers. The absence of CNV likely refers that this type of MNV is a pure retinal neovascularization disease.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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