Author: Bilal Haj Najeeb (Austria)
Co-authors: Gabor Deak, Georgios Mylonas, Stefan Sacu, Ursula Schmidt-Erfurth, Bianca Gerendas
Purpose
To explore the degenerative condition of fellow eyes of patients with newly diagnosed macular neovascularization type 3 (MNV3), and to verify whether the retinal-choroidal anastomosis (RCA), first recognized at the fibrosis stage, develops equally in all MNV types.
Setting/Venue
94 (76 solitary, 18 multifocal) eyes with MNV3 in addition to 96 eyes with MNV2 and 96 eyes with MNV1 as two control groups were included.
Methods
Multimodal imaging including optical coherence tomography, color fundus photography, fluorescein angiography was performed at least at three different visits. The degenerative condition including the development of fibrosis with or without RCA of fellow eyes over 24 months.
Results
In the solitary MNV3 group 32 (42.1%) eyes showed early/intermediate AMD, 25 (33%) eyes showed MNV3, 11 (14.5%) eyes experienced fibrosis, of which 4 (5.2%) had a RCA, 7 (9.2%) eyes had atrophy after resolved MNV3 and 1 (1.3%) eye developed MNV1. In the multifocal MNV3 group 2 (11.1%) eyes showed early/intermediate AMD. 9 (50%) eyes showed 15 MNV3 lesions. 4 (22.2%) eyes showed fibrosis, of which 2 (11.1%) manifested with a RCA. 3 (16.7%) eyes showed atrophy after resolved MNV3. The number of eyes with a RCA accounted for 40% of the total eyes with fibrosis. The count of simultaneous bilateral multifocal MNV3 was 5 (55.6%). No concurrent MNV1 or MNV2 were found. In MNV1 and MNV2 groups the scarring was seen in 11 (11.7%) and 12 (12.8%) eyes, but no eye developed a RCA. The higher incidence of RCA in MNV3 group was statistically significant compared to the control group (p:0.0001).
Conlusions
RCA is an exclusive clinical feature of MNV3 and this type (MNV3) was therefore first described by Oeller in 1904. The development of fibrosis in MNV3 has dramatically decreased after the introduction of anti-angiogenic therapy. Multifocal lesions are frequently bilateral and emerge simultaneously. In bilateral cases the multifocal phenotype in one eye tends to emerge prior to the development of a solitary one in the partner eye. The atrophy seen in treated eyes is related to the angiogenic features rather than coexisting dry AMD.
Financial Disclosure
BHN: Retinsight, unrelated to this study. GD: none. GM:none. SS: Roche, Novartis, Bayer all unrelated to this study, USE: Bayer/Novartis/Boehringer-Ingelheim/Alcon/Kinarus, all unrelated to this study. BG: Novartis/Kinarus/IDx, all unrelated to this study.
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