Comparison of Pigment Epithelium Composition Indices between neovascular age-related macular degeneration and polypoidal choroidal vasculopathy

Abstract

Purpose : Polypoidal choroidal vasculopathy (PCV) and wet age-related macular degeneration (wAMD) both present with pigment epithelial detachments (PED) and result in significantly different outcomes with similar therapeutic approaches. The aim of the study was to compare the PED fibrous composition index (PEDCI-F) between PCV and AMD and evaluate PEDCI-F as a predictor for treatment outcome.

Methods : Retrospective chart reviews of 38 eyes (35 patients) with PCV and 36 eyes (34 patients) with wAMD undergoing anti-VEGF monotherapy, were done. Visits were recorded at 0- 3-, 6-, and 12-month marks. OCT images were filtered, segmented, and analyzed for PED lesion heterogeneity. The heterogeneity characterized the lesion as fibrous, serous, and neovascular. PEDCI-F is the ratio of fibrous tissue area to the total PED lesion. Other biomarkers collected included LogMAR best-corrected visual acuity (VA), anti-VEGF injections received central macular thickness (CMT), and sub-foveal choroidal thickness (SFCT). For comparisons, Mann-Whitney and Wilcoxon (p < 0.05) were done on GraphPad Prism (v. 9.5.0).

Results : The mean age of PCV subjects was 66.8 ± 5.9 years with 16 females. Baseline PEDCI-F was 0.2359 ± 0.2626 & VA was 0.62 ± 0.62 (Snellen’s equivalent 20/83). The mean age of wAMD subjects was 78.1 ± 9.2 years with 26 females Baseline PEDCI-F was 0.6350 ± 0.5317 & VA was 0.45 ± 0.25 (Snellen’s equivalent 20/56). There was a significantly lower (p < 0.01) PEDCI-F in PCV eyes (0.1250 v. 0.5441) at baseline. There was a significant PEDCI-F increase in PCV eyes after 1 year (p < 0.05, + 0.0725), but not in wAMD eyes.

There was a significant improvement in VA in PCV patients (p < 0.01, 0.10 reduction), but not in wAMD eyes. wAMD eyes received significantly more injections in the first year of diagnosis than PCV patients (p < 0.01, 9 v. 3). CMT had a significant decrease at 3-months in both eyes with wAMD (p < 0.01, - 87 µm) & PCV (p < 0.01, - 74 µm).

Conclusions : By analyzing the PED fibrotic component of an OCT, PEDCI-F demonstrates clinical relevance in differentiating PCV and wAMD eyes. It also evaluates the pathophysiological status of fibrous structural changes under the PED during the treatment of the disease.

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

 

Average PEDCI-F of eyes with PCV or wAMD

 

Average LogMAR VA of eyes with PCV or wAMD