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TYPE 2 (SUBRETINAL) NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION ASSOCIATED WITH PURE RETICULAR PSEUDODRUSEN PHENOTYPE

Naysan, Jonathan MD; Jung, Jesse J. MD; Dansingani, Kunal K. MA, FRCOphth; Balaratnasingam, Chandrakumar MD; Freund, K. Bailey MD

doi: 10.1097/IAE.0000000000000758
Original Study
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Purpose: To report the association of pure type 2 neovascularization (NV) in age-related macular degeneration occurring almost exclusively in patients with reticular pseudodrusen.

Methods: An observational retrospective cohort study of all eyes receiving antivascular endothelial growth factor therapy for newly diagnosed neovascular age-related macular degeneration by a single practitioner over a 6-year period. Only patients with treatment-naive, pure type 2 NV who also had either pre-neovascular imaging of the study eye or imaging of a nonneovascular fellow eye available to determine baseline characteristics including drusen type and choroidal thickness were incuded.

Results: Of 694 patients treated for neovascular age-related macular degeneration, only 8 met the inclusion criteria with pure type 2 NV. Of these, 7 (88%) had exclusively reticular pseudodrusen (5 in the nonneovascular fellow eye, 2 in the study eye before developing NV). Six (75%) patients in the affected neovascular eye and 6 (75%) in the fellow nonneovascular eye had choroidal thickness <120 μm. Mean follow-up was 46 months (range, 3.0–63.3). Best-corrected vision improved from 20/89 (range, 20/30–20/796) at baseline to 20/60 (range, 20/20–20/399) at last follow-up.

Conclusion: Pure type 2 NV is rare in age-related macular degeneration, occurring almost exclusively in patients with reticular pseudodrusen and thin choroids.

Pure Type 2 neovascularization is rare in age-related macular degeneration. Reticular pseudodrusen are located above the retinal pigment epithelium best visualized by near-infrared reflectance and spectral domain optical coherence tomography. The authors describe the occurrence of pure Type 2 neovascularization in age-related macular degeneration that seems to occur almost exclusively in patients presenting with reticular pseudodrusen compared with other drusen phenotypes.

*Vitreous Retina Macula Consultants of New York, New York, New York;

LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York;

Department of Ophthalmology, New York University School of Medicine, New York, New York;

§Department of Ophthalmology, North-Shore Long Island Jewish Health System, Manhasset, New York; and

Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, New York.

Reprint requests: K. Bailey Freund, MD, Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022; e-mail: kbfnyf@aol.com

Supported by LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York and The Macula Foundation, Inc, New York, NY.

K. B. Freund is a consultant for Genentech, ThromboGenics, Ohr Pharmaceutical, Bayer HealthCare, Optovue, Optos, and Heidelberg Engineering. The other authors have no conflicting interests to disclose.

© 2016 by Ophthalmic Communications Society, Inc.
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