Abstract
Purpose :
To identify by means of multimodal imaging the characteristics of different subtypes of macular lesions secondary to exudative age-related macular degeneration (AMD).
Methods :
This is a cross -sectional, observational, retrospective study of all patients presenting with macular lesions secondary to exudative AMD at the Eye Hospital “Luigi Sacco” in Milan (Italy) between June 2021 and October 2022.
Fundus color pictures, optical coherence tomography (OCT), multicolor imaging, near-infrared reflectance (NIR) and blue autofluorescence (BAF) were obtained for all eyes included in this study. In addition, swept-source OCT angiography (OCTA) was also performed in 61 of 68 eyes. Kappa statistics (estimation of agreement), Chi square or Fisher’s exact test were used, as indicated, to evaluate statistical significance in the comparison of different values of various parameters.
Results :
Sixty-eight eyes of 66 patients with lesions secondary to exudative AMD were included in this study; thirty-five patients (53%) were females and 31 (47%) were males; average age was 79±9 years.
According to fundus color pictures, 56 of 68 (82.4%) and 12 of 68 (17.6%) lesions were classified respectively as fibrotic and non-fibrotic. In the statistical comparison between color and multicolor imaging, kappa statistics showed a value of 0.854, thus a highly significant agreement between the two methods (p<0.001).
Based on the OCT images, 19 of 68 (27.9%) lesions were classified as sub-retinal pigment epithelium, 24 of 68 (35.3%) as sub-retinal, and 25 of 68 (36.8%) as mixed.
BAF of non-fibrotic lesions showed a significantly (p=0.008) more frequent hyper-autofluorescent pattern (6 of 12 = 50%) than the fibrotic ones (7 of 55 = 12.7%); conversely, hypo-autofluorescent patterns were significantly (p<0.001) more frequent in fibrotic lesions (53 of 55 = 96.4%).
Finally, OCTA analysis demonstrated a flow volume below the lesions significantly higher (p<0.001) in the sub-retinal lesions (18 of 21 = 85.7%) while the flow volume above the lesion was significantly higher (p<0.001) in sub-RPE lesions (13 of 17 = 76.4%).
NIR patterns did not differ significantly (p>0.05) between fibrotic and non-fibrotic lesions.
Conclusions :
A multimodal imaging approach is instrumental in identifying features of AMD lesions undetectable by fundus color pictures (current “gold standard”), thus possibly changing the standards of treatment.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.