Author: Riccardo Sacconi (Italy)
Co-authors: Paolo Forte, Mariacristina Parravano, Alexandra Miere, Eric Souied, Francesco Bandello, Giuseppe Querques
Purpose
Type 3 macular neovascularization (MNV) is the second most frequent subtype of MNV in neovascular age-related macular degeneration (AMD). Patients diagnosed with unilateral type 3 lesions were reported to develop exudation in the fellow-eye during a 3-year follow-up. However, the diagnosis of a pre-clinical stage (i.e. nascent form) of the neovascularization may guide an early treatment of patients with better outcomes. The aim of the current study is to investigate evolving lesions in fellow eyes of exudative type 3 MNV patients by assessing the presence of a pre-clinical neovascular component.
Setting/Venue
This is a longitudinal study involving 3 retinal referral centers (the Medical Retina and Imaging Unit of the San Raffaele Scientific Institute in Milan, Italy, Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est in Creteil, France of and Bietti Foundation in Rome, Italy).
Methods
Patients affected by unilateral exudative treatment-naïve T3 MNV were enrolled. Fellow-eye was evaluated at the baseline and during 3-year FU using optical coherence tomography angiography (OCTA). Two retinal experts (readers) independently investigated the presence of a preclinical nascent T3 MNV (i.e. non-exudative form) and the development of an active T3 MNV (i.e. exudative form) over time.
Results
Twenty-five patients (mean age 82±9 years old) were enrolled. Among 25 eyes, 9 eyes (36%) displayed the presence of a nascent non-exudative T3 MNV at the baseline, that developed exudation (i.e. active form) after a mean of 9 ± 7 months. Five out of 25 eyes (20%) did not display neovessels at the baseline but showed a nascent non-exudative T3 after a mean of 12 ± 6 months before developed exudation. Five out of 25 eyes (20%) presented with an active exudative T3 MNV with no detectable nascent T3 stage, whereas 6 out of 25 eyes (24%) did not develop MNV during the follow-up. Overall, in the current series, T3 MNV in the fellow eye accounted for 76% (both exudative and non-exudative T3 MNV) over 3 years by combining prevalence and incidence.
Conlusions
The occurrence of a nascent non-exudative form of type 3 MNV is a frequent event in the fellow eye of patients affected by unilateral type 3 MNV and it often precedes the development of an active exudative form of type 3 MNV. OCTA allows better defining prevalence and incidence of T3 MNV in fellow eyes. Such approach may be employed to perform an early diagnosis and treatment of patients affected by type 3 MNV.
Financial Disclosure
None
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