Author: Mohammadkarim Johari (Iran, Islamic Republic of)
Co-authors: mohsen farvardin, masoud yasemi, younes azizpourfard
To determine the percentage of patients with pachychoroid neovasculopathy (PNV) among patients who have been misdiagnosed and treated with wet age-related macular degeneration (AMD)
For doing this retrospective cross-sectional study, patients over 60 years old, who were diagnosed with wet AMD, were re-evaluated. All patients were recalled for examination and imaging.
The present retrospective study was carried out on patients over 60 years of age, who were diagnosed with type I AMD-CNV (including new cases and cases treated with anti–vascular endothelial growth factor therapy (anti-VEGF).All patients were recalled for examination and imaging. Pachychoroid neovasculopathy was diagnosed if all of the following criteria were met: (1) Pigment epithelium detachment named ‘‘doublelayer’’ sign or CNV below the RPE. (2) Subfoveal choroidal thickness (SFCT) 300 µm or more in both eyes. (3) Presence of drusen-like deposits (total area < 125 µm circle or hard drusen < 63 µm findings corresponding to Age-Related Eye Disease Study Level 1) in both eyes or presence of pachydrusen which presented as a singular lesion, larger than 125 µm, with a scattered outer border. (4) Presence of central serous chorioretinopathy (CSCR), or pachychoroid pigment epitheliopathy (PPE) (included RPE abnormality regardless of CNV lesion, the presence of dilated choroidal vessels, or choroidal thickening below the type 1 CNV, or thinning of the choriocapillaris can be noted over the pachyvessel area or a history of CSCR) in each eye
120 patients (137 eyes) were recorded with wet AMD in the clinic. Finally, after complete re-evaluation, 94 (106 eyes) and 26 patients (31 eyes) were assigned to the AMD and the PNV group, respectively. Thus, a total of 20% of patients with primary mistake diagnosis of wet AMD, actually had PNV. The mean sub field choroidal thickness (SFCT) in the AMD and PNV groups was 173.89 ± 69 µm and 342 ± 27 µm, respectively, which the difference was statistically significant (p-value 0.001). Also, drusen was found in 69.9% and 24% of the cases with AMD and PNV, respectively.( p-value 0.001) The average number of intravitreal injections of anti-VEGF (vascular endothelial growth factor) required in the AMD and PNV groups was about 5 and 3, respectively, which was statistically significant (p-value 0.02)
About a one-fifth of wet AMD patients are actually due to PNV and often are misdiagnosed. Thus the disorder must be considered as important differential diagnosis of wet AMD.
)e authors have no conflicts of interest to declare.