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Jadnanansing AI, Martinez Ciriano JP, van Droogenbroeck J, Spielberg L, Vanhonsebrouck E. Perifoveal exudative vascular anomalous complex (PEVAC) resembling lesion in a patient with multiple myeloma. Am J Ophthalmol Case Rep 2024; 34:101891. [PMID: 38572297 PMCID: PMC10987793 DOI: 10.1016/j.ajoc.2023.101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 04/05/2024] Open
Abstract
Purpose To report a case of a perifoveal exudative vascular anomalous complex (PEVAC) resembling lesion in a patient with multiple myeloma. Observations A 56-year-old male with multiple myeloma presented with sudden moderate vision loss in the right eye. Best-corrected visual acuity was 20/25 in his right eye. Fundus examination showed a vascular irregularity in the perifoveal region. Fluorescein angiography (FA) revealed an isolated perifoveal aneurysmal lesion with minimal leakage. On optical coherence tomography (OCT) examination, a large oval structure with a hyperreflective wall and exudation was visualised. Three weeks later, spontaneous improvement of the intraretinal fluid was observed on OCT without treatment. However, 3 months later the macular edema recurred. The appearance of the aneurysmal lesion is similar to a PEVAC lesion, which is an isolated well-defined perifoveal intraretinal vascular abnormality presenting on OCT as a round hyperreflective structure with a dark lumen containing variably reflective material and is commonly associated with cystic intraretinal fluid. Conclusions and Importance PEVAC was originally described as occurring in healthy patients, but recent observations suggest that it also appears in association with other retinal/choroidal vascular abnormalities or underlying cardiovascular abnormalities. Our case supports this hypothesis by demonstrating a PEVAC resembling lesion in a patient with multiple myeloma.
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Affiliation(s)
| | | | | | - Leigh Spielberg
- Department of Ophthalmology, AZ Sint-Jan, Ruddershove 10, Bruges, Belgium
| | - Eva Vanhonsebrouck
- Department of Ophthalmology, AZ Sint-Jan, Ruddershove 10, Bruges, Belgium
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Cunha de Souza E, Tombolini B, Sacconi R, Bandello F, Querques G. A Brazilian case of exudative perifoveal vascular anomalous complex responsive to aflibercept intravitreal injections. Eur J Ophthalmol 2024; 34:NP68-NP72. [PMID: 37671424 DOI: 10.1177/11206721231200116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE To report a case of exudative perifoveal exudative vascular anomalous complex (ePVAC) in a Brazilian healthy patient that underwent a complete resolution after aflibercept intravitreal injections. CASE DESCRIPTION A 41-year-old healthy Brazilian man complained of acute central vision loss in his right eye (RE). Fundus examination showed a perifoveal hemorrhagic aneurysmal lesion, accompanied by several hard exudates in RE. On fluorescein angiography, these abnormalities showed a progressive hyperfluorescence with surrounding leakage. Optical coherence tomography (OCT) revealed a deep, perifoveal hyporeflective cystic space with a hyperreflective wall and hyperreflective material inside of fibrin-like aspect. Around this aneurism, intraretinal hyporeflective spaces suggestive of exudation were detected. Nor pathological flow signal, or telangiectatic dilations were evidenced on OCT-angiography. Therefore, a diagnosis of exudative ePVAC in RE was hypothesized. After an initial observation, the patient underwent three monthly aflibercept intravitreal injections (0.05 ml/2 mg), with a significative anatomical and functional improvement after two weeks from first dose. On last follow-up at five months from baseline, patient experienced no evidence of new exudation and a stable visual acuity. DISCUSSION Placental growth factor (PlGF) may impact on pericytes' dropout, and thus on ePVAC development. In contrast to the other anti-VEGF drugs, aflibercept is the only molecule contrasting PlGF. Therefore, aflibercept would act on ePVAC not as an anti-VEGF drug, but rather as an anti-PlGF one. CONCLUSION This report encouraged the use of aflibercept as a therapeutic option for ePVAC. Further studies are required to confirm our result and the impact of PlGF on ePVAC pathogenesis.
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Affiliation(s)
- Eduardo Cunha de Souza
- Department of Ophthalmology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Temkar S, Natarajan K, Deb AK, Sagar P. Exudative vascular anomalous complex-like lesion of the peripapillary area. Eur J Ophthalmol 2024; 34:NP83-NP86. [PMID: 37715627 DOI: 10.1177/11206721231202895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE Perifoveal exudative vascular anomalous complex is an uncommon retinal lesion of idiopathic origin characteristically described as an isolated, aneurysmal lesion of the perifoveal region. We report an unusual presentation of an exudative vascular anomalous complex-like lesion affecting the peripapillary area. CASE DESCRIPTION A 69-year-old diabetic woman presented with blurred vision in her left eye for two months. Fundus examination of the left eye showed a small, reddish-orange lesion just supratemporal to the optic disc with perifoveal hard exudates and retinal thickening. Fundus fluorescein angiography demonstrated a peripapillary hyperfluorescent lesion with minimal leakage. Ocular coherence tomography showed an oval structure extending throughout the outer and inner plexiform and nuclear layers with a hyper-reflective wall accompanied by subfoveal and intraretinal fluid suggestive of an eVAC-like lesion in the peripapillary area. Intravitreal anti-vascular endothelial growth factor injection was given, and the lesion persisted even three weeks after the injection. Later, focal laser photocoagulation of the aneurysmal lesion was done. At 6 weeks follow-up, a complete resolution of the aneurysmal lesion with a marked decrease in retinal edema and an improvement of the visual acuity was observed. CONCLUSION Exudative intraretinal aneurysmal lesions can occur in areas other than perifoveal area. OCT is an useful investigation for knowing their characteristics and the response to treatment. These aneurysmal lesions irrespective of their location can be called by the name eVAC-like or more aptly retinal capillary macro aneurysms (RCM).
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Affiliation(s)
| | | | | | - Pradeep Sagar
- Ophthalmology, Sankara Eye Hospital, Shivamogga, India
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Damasceno N, Horowitz S, Yannuzzi NA, Flynn H, Farah M, Damasceno E. Perifoveal exudative vascular anomalous complex and resembling lesions treated with intravitreal triamcinolone. Eur J Ophthalmol 2024; 34:NP84-NP89. [PMID: 37246399 DOI: 10.1177/11206721231178995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To report the use of intravitreal triamcinolone to treat macular edema associated with isolated perifoveal exudative vascular anomalous complex (PVAC) and resembling lesion (PVAC-RL). METHODS In this case series, three diabetic patients (3 eyes) with PVAC-RLs and one healthy patient (1 eye) with PVAC lesion associated with cystic spaces underwent three intravitreal injections of aflibercept before switching to one intravitreal triamcinolone injection in each patient. RESULTS Macular edema improved from 297.5 ± 8.10 μm, at baseline, to 269.2 ± 8.89 μm, after triamcinolone; whereas visual acuity improved from 20/38 to 20/26 (ETDRS). CONCLUSION PVAC and PVAC-RL are rare and often misdiagnosed lesions that may be associated with decreased vision. Our outcomes suggest that intravitreal injection of triamcinolone may be an effective and affordable treatment for PVAC and PVAC-RL with intraretinal fluid.
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Affiliation(s)
- Nadyr Damasceno
- Department of Ophthalmology, Marcilio Dias Navy Hospital, Rio de Janeiro, RJ, Brazil
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, SP, Brazil
| | - Soraya Horowitz
- Department of Ophthalmology, Marcilio Dias Navy Hospital, Rio de Janeiro, RJ, Brazil
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bacom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry Flynn
- Department of Ophthalmology, Bacom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michel Farah
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, SP, Brazil
| | - Eduardo Damasceno
- Department of Ophthalmology, Federal Fluminense University, School of Medicine, Niteroi, RJ, Brazil
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Sagar P, Sahare H, Shanmugam PM, Biswal S, Ravishankar HN. Laser photocoagulation of a hypofluorescent perifoveal exudative vascular anomalous complex/capillary macroaneurysm. Eur J Ophthalmol 2023; 33:NP87-NP91. [PMID: 36567497 DOI: 10.1177/11206721221149064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To report successful treatment of a hypofluorescent perifoveal exudative vascular anomalous complex (PEVAC)/capillary macroaneurysm. CASE DESCRIPTION A 63 year old healthy gentleman had a perifoveal isolated aneurysmal lesion with white rim. Optical coherence tomography (OCT) showed cystoid macular edema (CME) with neurosensory detachment. The aneurysmal lesion was seen in the inner retina as a hyperreflective intraretinal structure with a heterogenous lumen suggestive of PEVAC/capillary macroaneurysm. OCT angiography showed a capillary loop and a slightly hyperreflective lesion at the tip of the loop in the superficial capillary plexus slab. Minimal reduction in edema was noted following one dose of intravitreal triamcinolone (2 mg). Fundus fluorescein angiography performed at 6 weeks demonstrated the capillary loop, but the aneurysmal lesion remained hypofluorescent with no definite leak in the late phase. Few perifoveal microaneurysms were seen in both the eyes. Six weeks later, focal laser photocoagulation of the aneurysmal lesion was performed, which resulted in complete resolution of macular edema at 1 month. There was no recurrence of macular edema till his recent follow up, which is 4 month post laser. DISCUSSION PEVAC is typically described as unifocal lesion and is not associated with other retinal vascular abnormalities. But in this case, in addition to the lesion, perifoveal microaneurysms were seen in both the eyes. Despite the absence of leak on fundus fluorescein angiography, targeted focal laser photocoagulation resulted in complete resolution of macular edema at 1 month. CONCLUSION Laser photocoagulation would be helpful even in hypofluorescent PEVAC/capillary macroaneurysms.
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Affiliation(s)
- Pradeep Sagar
- Department of Vitreo-retina, Sankara Eye Hospital, Shimoga, KA, India
| | - Harshal Sahare
- Department of Vitreo-retina, Sankara Eye Hospital, Shimoga, KA, India
| | - P Mahesh Shanmugam
- Department of Vitreo-retina and Ocular Oncology, Sankara Eye Hospital, Bangalore, KA, India
| | - Suchitra Biswal
- Department of Vitreo-retina, Sankara Eye Hospital, Shimoga, KA, India
| | - H N Ravishankar
- Department of Vitreo-retina, Sankara Eye Hospital, Shimoga, KA, India
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Kayabaşı M, Köksaldı S, Mansour AM, Ayhan Z, Saatci AO. Intraretinal Macroaneurysms and Multimodal Imaging: A Retrospective Analysis. Clin Ophthalmol 2023; 17:3195-3205. [PMID: 37908897 PMCID: PMC10613568 DOI: 10.2147/opth.s436652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
Purpose To analyze the multimodal imaging characteristics of intraretinal macroaneurysms. Patients and Methods Intraretinal aneurysms larger than 150 μm in diameter on fluorescein angiography were termed as intraretinal macroaneurysm and grouped as primary and secondary according to the absence or presence of any coexisting posterior segment diseases. Results A total of 20 intraretinal macroaneurysms were observed in 18 eyes of 18 patients. Mean age of the cohort was 65.44 ± 9.14 years (Range; 49-82 years). Mean diameters of intraretinal macroaneurysms were 238.20 ± 61.12 μm (Range; 163.00-292.50 μm) and 242.72 ± 49.58 μm (Range; 168.00-328.00 μm) on fluorescein angiography and optical coherence tomography, respectively. Primary group had 10 eyes with 11 intraretinal macroaneurysms, whereas eight eyes had nine intraretinal macroaneurysms in the secondary group. Three of the eight eyes (37.5%) had diabetic retinopathy, four (50%), retinal vein occlusion, and one (12.5%), posterior uveitis in the secondary group. No statistically significant differences were found between the two groups in terms of age, sex, presence of intraretinal or subretinal fluid, the mean age, the mean central macular thickness, the mean distance of intraretinal macroaneurysms from the fovea, the mean diameter of intraretinal macroaneurysms measured on fluorescein angiography, and the mean diameter of intraretinal macroaneurysms measured on optical coherence tomography. Presence of intraretinal fluid was significantly more frequent than the presence of subretinal fluid in all eyes (p = 0.004). Conclusion Intraretinal macroaneurysms are diagnosed more and more with the utilization of multimodal imaging techniques. We propose a simple classification system in order to help achieving a standardized terminology and ensure consistent understanding. The classification can be simplified as primary or secondary intraretinal macroaneurysm according to the absence or presence of the associated posterior segment disorders.
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Affiliation(s)
- Mustafa Kayabaşı
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Seher Köksaldı
- Department of Ophthalmology, Mus State Hospital, Mus, Turkey
| | - Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Ziya Ayhan
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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Simon A, Mercier AE, Chan G, Williamson W. [Multimodal imaging of Perifoveal Exudative Vascular Anomalous Complex (PEVAC)]. J Fr Ophtalmol 2023; 46:968-971. [PMID: 37481453 DOI: 10.1016/j.jfo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/09/2023] [Indexed: 07/24/2023]
Affiliation(s)
- A Simon
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France.
| | - A-E Mercier
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
| | - G Chan
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
| | - W Williamson
- Service d'ophtalmologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
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Zucchiatti I, Sacconi R, Saladino A, Bandello F, Querques G. Perifoveal Vascular Anomalous Complex and the Spectrum of Degenerative Microvascular Macular Diseases. Retina 2023; 43:1219-1225. [PMID: 37315570 DOI: 10.1097/iae.0000000000003861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Ilaria Zucchiatti
- Ophthalmology Unit, Division of Head and Neck, IRCSS San Raffaele Hospital, Milan, Italy
| | - Riccardo Sacconi
- Ophthalmology Unit, Division of Head and Neck, IRCSS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Saladino
- Ophthalmology Unit, Division of Head and Neck, IRCSS San Raffaele Hospital, Milan, Italy
| | - Francesco Bandello
- Ophthalmology Unit, Division of Head and Neck, IRCSS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Querques
- Ophthalmology Unit, Division of Head and Neck, IRCSS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Sotomayor-Toribio M, López-Herrero F, Sánchez-Vicente JL, González-Jáuregui B, Rodríguez-Fernández C, Suárez-Pérez J. Perifoveal exudative vascular anomalous complex (PEVAC). Arch Soc Esp Oftalmol (Engl Ed) 2023:S2173-5794(23)00087-7. [PMID: 37285962 DOI: 10.1016/j.oftale.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/27/2023] [Indexed: 06/09/2023]
Abstract
We present three cases of patients aged 66, 80 and 23, who presented unilateral vision loss. Optical coherence tomography (OCT) in all of them showed macular oedema and a rounded lesion with hyperreflective wall, and fluorescein angiography (FAG) in two of them showed hyperfluorescent perifoveal aneurysmal dilations with exudation. None of the cases showed response to treatment after one year of follow-up, finally being diagnosed with Perifoveal Exudative Vascular Anomalous Complex (PEVAC).
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Affiliation(s)
- M Sotomayor-Toribio
- Departmento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - F López-Herrero
- Departmento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Sánchez-Vicente
- Departmento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - B González-Jáuregui
- Departmento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - C Rodríguez-Fernández
- Departmento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Suárez-Pérez
- Departmento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Kang YK, Park HS. MULTIPLE-SESSION SUBTHRESHOLD MICROPULSE LASER THERAPY FOR EXUDATIVE PERIFOVEAL VASCULAR ANOMALOUS COMPLEX: A CASE REPORT. Retin Cases Brief Rep 2023; 17:324-328. [PMID: 34293778 PMCID: PMC10121362 DOI: 10.1097/icb.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a case of exudative perifoveal vascular anomalous complex treated with a 532-nm subthreshold micropulse laser unresponsive to intravitreal injections. METHODS A case report. RESULTS A 65-year-old woman presented with blurred vision in the left eye for 1 month. An isolated perifoveal aneurysm surrounded by retinal hemorrhages and hard exudates was revealed in fundus examination, and optical coherent tomography showed a round lesion with a hyperreflective wall, subretinal fluid, and an intraretinal cyst. She was diagnosed with exudative perifoveal vascular anomalous complex and received four intravitreal injections. However, her best-corrected visual acuity decreased, and an aneurysmal lesion with macular edema persisted for approximately 6 months. Three sessions of 532-nm subthreshold micropulse laser therapy around the aneurysm were applied because the intravitreal injection treatment was ineffective. Since the last session, macular edema disappeared, the involuted lesion remained substantially stable without recurrence, and her best-corrected visual acuity improved without visual field defect. CONCLUSION To our knowledge, this is the first report of a successful subthreshold micropulse laser treatment for an exudative perifoveal vascular anomalous complex lesion, and it could be a safe and effective method for the patient unresponsive to intravitreal injections.
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Affiliation(s)
- Yong Koo Kang
- Department of Ophthalmology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea.
| | - Han Sang Park
- Department of Ophthalmology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea.
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Sacconi R, Sarraf D, Sadda SR, Freund KB, Servillo A, Fogel Levin MM, Costanzo E, Corradetti G, Cabral D, Zur D, Trivizki O, Parravano M, Bandello F, Loewenstein A, Querques G. Nascent Geographic Atrophy as a Predictor of Type 3 Macular Neovascularization Development. Ophthalmol Retina 2023:S2468-6530(23)00038-6. [PMID: 36736896 DOI: 10.1016/j.oret.2023.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the association of nascent geographic atrophy (GA) preceding the development of exudative type 3 macular neovascularization (MNV) in patients with age-related macular degeneration (AMD). DESIGN Retrospective longitudinal study. PARTICIPANTS Patients with AMD diagnosed with treatment-naive exudative type 3 MNV in 1 or both eyes were evaluated. Inclusion criteria included serial tracked structural OCT examinations for ≥ 2 years before the detection of exudative type 3 MNV. METHODS Clinical characteristics and retinal imaging, including structural OCT at baseline and at each follow-up examination, were analyzed. Eyes showing the presence of nascent GA during the follow-up were selected for analysis of prevalence, and clinical characteristics at the site of subsequent type 3 MNV development. MAIN OUTCOME MEASURES Description of the prevalence and clinical characteristics of nascent GA at the site of subsequent type 3 MNV development. RESULTS Overall, 97 eyes affected by type 3 MNV meeting inclusion criteria were analyzed. Of 97 eyes (71 patients), 22 eyes of 21 patients (mean age 82 ± 9 years) showed nascent GA preceding exudative type 3 MNV. The observed prevalence of nascent GA preceding exudative type 3 MNV was 22.7% (95% confidence interval, 14.4%-31.0%). Exudative type 3 MNV developed a mean of 9 ± 6 months after detection of nascent GA. The presence of reticular pseudodrusen in the study eye did not significantly influence the timing of exudative type 3 MNV development after the observation of nascent GA (P > 0.1 in all analyses). Reduced best-corrected visual acuity was recorded at the exudative type 3 stage in comparison with the nascent GA stage (P = 0.003). CONCLUSIONS As nascent GA may precede the development of exudative type 3 MNV, the detection of nascent GA in eyes with AMD may warrant closer surveillance to identify early exudative type 3 MNV warranting treatment. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, University of California-Los Angeles, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| | - Andrea Servillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Meira Miri Fogel Levin
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
| | | | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, University of California-Los Angeles, Los Angeles, California
| | - Diogo Cabral
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Trivizki
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Zucchiatti I, Sacconi R, Querques G. Re: Cabral et al: Volume rendering of deep retinal age-related microvascular anomalies. Ophthalmol Retina (2022;6:1185-1193). Ophthalmol Retina 2023; 7:e3. [PMID: 36424281 DOI: 10.1016/j.oret.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/25/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Ilaria Zucchiatti
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific, Institute, Milan, Italy
| | - Riccardo Sacconi
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific, Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Querques
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific, Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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Berlin A, Cabral D, Chen L, Messinger JD, Balaratnasingam C, Mendis R, Ferrara D, Freund KB, Curcio CA. Histology of type 3 macular neovascularization and microvascular anomalies in treated age-related macular degeneration: a case study. Ophthalmology Science 2023; 3:100280. [PMID: 36970117 PMCID: PMC10033755 DOI: 10.1016/j.xops.2023.100280] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
Purpose To investigate intraretinal neovascularization and microvascular anomalies by correlating in vivo multimodal imaging with corresponding ex vivo histology in a single patient. Design A case study comprising clinical imaging from a community-based practice, and histologic analysis at a university-based research laboratory (clinicopathologic correlation). Participants A White woman in her 90s treated with numerous intravitreal anti-VEGF injections for bilateral type 3 macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). Methods Clinical imaging comprised serial infrared reflectance, eye-tracked spectral-domain OCT, OCT angiography, and fluorescein angiography. Eye tracking, applied to the 2 preserved donor eyes, enabled the correlation of clinical imaging signatures with high-resolution histology and transmission electron microscopy. Main Outcome Measures Histologic/ultrastructural descriptions and diameters of vessels seen in clinical imaging. Results Six vascular lesions were histologically confirmed (type 3 MNV, n = 3; deep retinal age-related microvascular anomalies [DRAMAs], n = 3). Pyramidal (n = 2) or tangled (n = 1) morphologies of type 3 MNV originated at the deep capillary plexus (DCP) and extended posteriorly to approach without penetrating persistent basal laminar deposit. They did not enter the subretinal pigment epithelium (RPE)-basal laminar space or cross the Bruch membrane. Choroidal contributions were not found. The neovascular complexes included pericytes and nonfenestrated endothelial cells, within a collagenous sheath covered by dysmorphic RPE cells. Deep retinal age-related microvascular anomaly lesions extended posteriorly from the DCP into the Henle fiber and the outer nuclear layers without evidence of atrophy, exudation, or anti-VEGF responsiveness. Two DRAMAs lacked collagenous sheaths. External and internal diameters of type 3 MNV and DRAMA vessels were larger than comparison vessels in the index eyes and in aged normal and intermediate AMD eyes. Conclusions Type 3 MNV vessels reflect specializations of source capillaries and persist during anti-VEGF therapy. The collagenous sheath of type 3 MNV lesions may provide structural stabilization. If so, vascular characteristics may be useful in disease monitoring in addition to fluid and flow signal detection. Further investigation with longitudinal imaging before exudation onset will help determine if DRAMAs are part of the type 3 MNV progression sequence. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Arruabarrena C, Liaño G, Hernáez-Leonato JM, Martínez-Sánchez M, Cañas-Martín J, Teus MA. Selective Focal Laser Therapy as the Primary Treatment for Exudative Perifoveal Vascular Anomalous Complex (ePVAC): Case Series and Literature Review. Ophthalmic Surg Lasers Imaging Retina 2023; 54:43-49. [PMID: 36626213 DOI: 10.3928/23258160-20221219-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Perifoveal anomalous exudative vascular complex (PEVAC) was first described in 2011. Since then, individual clinical cases and a couple of case series have been published, and their characteristics have been studied in multi-modal images. To date, there is no consensus on its treatment. Initially, it was thought that PEVACs could be left to spontaneous evolution because they presented a slow progression. But it has been shown that the growth of the lesion covers a spectrum from non-exudative lesions to PEVAC with vision impairment over time. We present an updated bibliographic review of this pathology. We explain the changes in the diagnostic criteria that have been undergone. And we focus the discussion on selective treatment with focal laser, which has shown an excellent anatomical response and visual improvement or stabilization in the cases described and in our series of three patients systematically treated with focal laser. [Ophthalmic Surg Lasers Imaging Retina 2023;54:43-49.].
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Cabral D, Ramtohul P, Fradinho AC, Freund KB. Volume Rendering of Deep Retinal Age-Related Microvascular Anomalies. Ophthalmol Retina 2022; 6:1185-1193. [PMID: 35772694 DOI: 10.1016/j.oret.2022.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To characterize and distinguish non-neovascular deep retinal age-related microvascular anomalies (DRAMA) from type 3 macular neovascularization (MNV) using volume rendering of OCT and OCT angiography (OCTA). DESIGN Retrospective, consecutive case series. SUBJECTS Consecutive patients with age-related macular degeneration (AMD) exhibiting de novo non-neovascular abnormalities within the deep vascular plexus (DCP), as detected using high-resolution (High-Res) spectral-domain (SD) and swept-source (SS) OCT or OCTA. Patients with retinal vascular alterations attributable to other disease entities were excluded. METHODS Complete ophthalmic examination and multimodal imaging, including confocal fundus photography (CFP), SD-OCT, High-Res SD-OCT and OCTA, and volume-averaged SS-OCTA. The volume renderings of High-Res OCTA and averaged SS-OCTA were used to analyze capillary abnormalities and inflow or outflow connectivity pathways. MAIN OUTCOME MEASURES The primary outcomes were the characteristics of capillary abnormalities (number, size, shape, reflectivity, and location) and inflow or outflow connectivity pathways. The secondary outcomes were nearby changes in CFP and structural OCT (hyperreflective foci [HRF], outer retinal atrophy, and retinal pigment epithelium [RPE] atrophy). RESULTS From 8 eyes of 8 patients, 2 subtypes of DRAMA were identified: small-diameter perifoveal capillary dilations with hyperreflective walls within the inner nuclear layer (type 1, n = 4) and vascular outpouchings, typically multiple, extending posteriorly into the Henle fiber layer, with reflectivity similar to adjacent normal retinal capillaries (type 2, n = 10). Four eyes had both subtypes of DRAMA. The 3-dimensional visualization of OCTA data demonstrated DRAMA corresponding to the dilations of DCP capillaries without direct inflow or outflow connections to the superficial plexus. Fundus photographs showed circular red dots in 3 eyes, all corresponding to type 1 DRAMA. In all the cases, DRAMA colocalized with HRF. No lesions were found anterior to the areas of the RPE or outer retina atrophy. Asymptomatic intraretinal exudation varied through a follow-up duration of up to 6 years, with no lesions progressing to type 3 MNV. CONCLUSIONS In eyes with non-neovascular AMD, DRAMA include 2 types of capillary dilations occurring without the remodeling of the surrounding vascular network. Deep retinal age-related microvascular anomalies can resemble microvascular changes due to other causes and can masquerade as type 3 MNV. Mild intraretinal exudation can vary during follow-up, without progression to type 3 MNV.
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Affiliation(s)
- Diogo Cabral
- Vitreous Retina Macula Consultants of New York, New York, New York; Nova Medical School Research, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York
| | - Ana C Fradinho
- Nova Medical School Research, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York.
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Herda N, Semoun O, Srour M, Amoroso F, Baker M, Capuano V, Colantuono D, Cohen SY, Querques G, Souied EH. Atypical case of perifoveal exudative vascular anomalous complex associated with pachychoroid pigment epitheliopathy. Am J Ophthalmol Case Rep 2022; 28:101691. [PMID: 36090303 PMCID: PMC9449734 DOI: 10.1016/j.ajoc.2022.101691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/09/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose Observations Conclusion and importance
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Affiliation(s)
- Nabil Herda
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
- Corresponding author. Hopital intercommunal de Créteil, Department of Ophtalmology, 40 Avenue de Verdun, 94000, Créteil, France.
| | - Oudy Semoun
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - Mayer Srour
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - Francesca Amoroso
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - May Baker
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - Vittorio Capuano
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - Donato Colantuono
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - Salomon Y. Cohen
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - Giuseppe Querques
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Eric H. Souied
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
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Jeong A, Kang W, Sagong M. MULTIMODAL IMAGING FEATURES AND TREATMENT RESPONSES OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO CENTRAL SEROUS CHORIORETINOPATHY. Retina 2022; 42:2326-2335. [DOI: 10.1097/iae.0000000000003615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Zhang K, Rachitskaya A. A Review of Perifoveal Exudative Vascular Anomalous Complex. Curr Ophthalmol Rep 2022. [DOI: 10.1007/s40135-022-00293-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Bacci T, Fisher YL, Freund KB, Sadda SR. Diagnostic and Therapeutic Challenges. Retina 2022; 42:1623-7. [PMID: 34510131 DOI: 10.1097/IAE.0000000000003302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Tombolini B, Cavalleri M, Sacconi R, Querques L, Zucchiatti I, Bandello F, Querques G. Progressive resolution of exudation from perifoveal vascular anomalous complex: A possible role of diclofenac therapy? Am J Ophthalmol Case Rep 2022; 26:101472. [PMID: 35282605 PMCID: PMC8907685 DOI: 10.1016/j.ajoc.2022.101472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/21/2022] Open
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21
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Sagar P, Biswal S, Shanmugam PM, Ravishankar HN, Pawar R. Targeted laser photocoagulation of larger capillary aneurysms with rim in diabetic macular edema. Taiwan J Ophthalmol 2022. [DOI: 10.4103/2211-5056.353130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Fu M, Hu P, Zhang G, Huang L, Xu H, Huang J, Wu M, Chen Y. Case Report: A Case of Perifoveal Exudative Vascular Anomalous Complex With a Good Prognosis. Front Med (Lausanne) 2021; 8:757313. [PMID: 34966751 PMCID: PMC8710488 DOI: 10.3389/fmed.2021.757313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
Significance: Perifoveal exudative vascular anomalous complex (PEVAC) is a unique clinical lesion. It manifests as isolated lesions and is easily misdiagnosed. Thus far, few PEVAC case reports have been published. PEVAC is typically inconsistent with other reported macular lesions. Purpose: To report our 24-month follow-up experience on the treatment of PEVAC with a micropulse laser (MPL). Case Report: A 56-year-old Chinese woman with no history of other diseases complained of decreased vision in her left eye that had persisted for more than 1 year. Comprehensive ophthalmic examinations were performed, including a vision test, slit lamp fundus exam, optical coherence tomography (OCT), optical coherence tomography angiography (OCT-A), fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA). Intravitreal injection of ranibizumab was ineffective, and bleeding, exudation and visual acuity were not improved. After two rounds of micropulse laser (MPL) treatment, the patient was followed up, and the prognosis was good. Conclusion: PEVAC is very rare, and early diagnosis is important, as the lesions readily cause irreversible damage. Our results indicate that an MPL can be used as an alternative treatment for PEVAC patients.
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Affiliation(s)
- Min Fu
- Department of Ophthalmology, Daping Hospital of Army Characteristic Medical Center, Chongqing, China
| | - Pan Hu
- Department of Ophthalmology, Daping Hospital of Army Characteristic Medical Center, Chongqing, China
| | - Gang Zhang
- Department of Medicine, 953 Hospital of People's Liberation Army (PLA), Xizang, China
| | - Ludonghan Huang
- Department of Ophthalmology, Daping Hospital of Army Characteristic Medical Center, Chongqing, China
| | - Huan Xu
- Department of Ophthalmology, Daping Hospital of Army Characteristic Medical Center, Chongqing, China
| | - Ju Huang
- Department of Ophthalmology, Daping Hospital of Army Characteristic Medical Center, Chongqing, China
| | - Meihui Wu
- Nursing Teaching and Research Section, Daping Hospital of Army Characteristic Medical Center, Chongqing, China
| | - Yanli Chen
- Department of Ophthalmology, Daping Hospital of Army Characteristic Medical Center, Chongqing, China
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Smid LM, Verhoekx JSN, Martinez Ciriano JP, Vermeer KA, Yzer S. Multimodal imaging comparison of perifoveal exudative vascular anomalous complex and resembling lesions. Acta Ophthalmol 2021; 99:553-558. [PMID: 33210824 PMCID: PMC8451757 DOI: 10.1111/aos.14650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
Purpose Perifoveal exudative vascular anomalous complex (PEVAC) was initially described as an isolated aneurysmal lesion in healthy eyes. Similar aneurysmal abnormalities may occur in association with retinal vascular diseases such as diabetic retinopathy or retinal vein occlusions (PEVAC‐resembling). The aim of this study was to compare several imaging characteristics of PEVAC and PEVAC‐resembling lesions. Methods Ten eyes with a PEVAC and 27 eyes with a PEVAC‐resembling lesion were included in this cross‐sectional study. They were all imaged with optical coherence tomography (OCT), OCT angiography (OCT‐A) and colour fundus photography (CFP). Several clinical, morphological and vascular characteristics were assessed and compared between both PEVAC types. Results All PEVAC lesions were unilateral, while PEVAC‐resembling lesions appeared bilateral in 23% of patients (p > 0.05). Unilateral multifocal PEVAC‐resembling lesions were more frequently observed (56%) than unilateral multifocal PEVAC lesions (10%, p < 0.01). Furthermore, 90% of the PEVAC lesions were located within 500 µm from the centre of the fovea, while this was only true for 56% of the PEVAC‐resembling lesions (p > 0.05). No notable differences were observed in other studied characteristics. Conclusions The clinical, morphological and vascular features of PEVAC and PEVAC‐resembling lesions are similar based on multimodal imaging. Given the bilaterality and multifocality seen in PEVAC‐resembling lesions, an underlying retinal vascular disease may stimulate the quantity of aneurysmal abnormalities. Due to the similarities with PEVAC‐resembling lesions, PEVAC may also be considered a microangiopathy but with an unknown origin.
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Affiliation(s)
| | | | | | | | - Suzanne Yzer
- Medical Retina Service Rotterdam Eye Hospital Rotterdam The Netherlands
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24
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Remolí-Sargues L, Montero-Hernández J, Monferrer Adsuara C, Castro Navarro V, Cervera-Taulet E. Perifoveal exudative vascular anomalous complex treated with navigated retina laser. J Fr Ophtalmol 2021; 45:e9-e11. [PMID: 34340884 DOI: 10.1016/j.jfo.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 10/20/2022]
Affiliation(s)
- L Remolí-Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain.
| | - J Montero-Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain
| | - C Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain
| | - V Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain
| | - E Cervera-Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain
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Rehmani AS, Banaee T, Makkouk F. Subretinal leakage of a retinal capillary macroaneurysm - a case report. BMC Ophthalmol 2021; 21:221. [PMID: 34001046 PMCID: PMC8128355 DOI: 10.1186/s12886-021-01984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Report a rare case of retinal capillary macroaneurysm with associated subretinal fluid. CASE PRESENTATION A 71-year-old male underwent full ophthalmic examination including Optical Coherence Tomography (OCT), Fluorescein Angiography (FA). Fundus examination showed moderate non-proliferative diabetic retinopathy of both eyes with scattered microaneurysms. On initial visit, FA displayed a hyperfluorescent lesion with leakage on late frames in the left eye. OCT revealed the lesion to be spheroid with a hyperreflective wall and hyporeflective lumen in the inner retina, corresponding to a capillary macroaneurysm. Intraretinal cystic fluid surrounded the lesion. On subsequent visit 7 months later, subretinal fluid in the location of the capillary macroaneurysm was noted on OCT. Vision was maintained at 20/30-2 OD, 20/40 OS throughout. No treatment was necessary. CONCLUSION Subretinal fluid from the capillary macroaneurysm likely developed from its juxtafoveal location and discontinuity of the external limiting membrane (ELM); a barrier preventing flow of intraretinal fluid to the outer retina.
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Affiliation(s)
- Ahmad S Rehmani
- University of Texas Medical Branch, 700 University Boulevard, Galveston, Tx, 77555, USA.
| | - Touka Banaee
- University of Texas Medical Branch, 700 University Boulevard, Galveston, Tx, 77555, USA
| | - Fuad Makkouk
- University of Texas Medical Branch, 700 University Boulevard, Galveston, Tx, 77555, USA
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Sacconi R, Brambati M, Miere A, Costanzo E, Capuano V, Borrelli E, Battista M, Parravano M, Souied EH, Bandello F, Querques G. Characterisation of macular neovascularisation in geographic atrophy. Br J Ophthalmol 2021; 106:1282-1287. [PMID: 33836986 DOI: 10.1136/bjophthalmol-2021-318820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 11/04/2022]
Abstract
AIM To characterise macular neovascularisation (MNV) developing in eyes affected by geographic atrophy (GA). METHODS In this multicentric longitudinal study involving three retina referral centres, patients previously affected by GA who developed an active MNV were included. Patients were investigated using structural optical coherence tomography (OCT), fundus autofluorescence, OCT-angiography and dye angiographies. Patients were treated with ProReNata antivascular endothelial growth factor (VEGF) injections and were revaluated after treatment. RESULTS Among 512 patients previously diagnosed with GA, 40 eyes of 40 patients (mean age 80.8±7.9 years, mean GA area 8.73±7.39 mm2) presented with treatment-naïve exudative MNV (accounting for an estimated prevalence of 7.81%; 5.49 to 10.13, 95% CIs) and thus were included in the analysis. 67.5% of MNVs were classified as type 2 MNV, 25% as type 1, 2.5% as type 3 and 5% as mixed phenotype. In 92.5% of cases, active MNV in GA showed subretinal hyperreflective material with or without evidence of subretinal/intraretinal hyporeflective exudation. During a mean follow-up of 28±25 months, patients were treated with 6.6±6.3 anti-VEGF injections, with 2.9±1.4 injections in the first year of treatment. No patient developed GA enlargement in the area of MNV. CONCLUSIONS MNVs in GA showed different features and therapeutic response in comparison to previously reported features of MNV in age-related macular degeneration (AMD) without GA. For these reasons, the combined phenotype (ie, GA with neovascular AMD) should be considered as a distinct entity in the research and clinical setting.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Clinical Research Centre, Hospital Intercommunal de Creteil, Creteil, France
| | - Maria Brambati
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | | | - Vittorio Capuano
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Eric H Souied
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy .,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Vella G, Sacconi R, Borrelli E, Bandello F, Querques G. Polypoidal choroidal vasculopathy in a patient with early-onset large colloid drusen. Am J Ophthalmol Case Rep 2021; 22:101085. [PMID: 33898862 PMCID: PMC8056241 DOI: 10.1016/j.ajoc.2021.101085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of a 46-year-old patient affected by polypoidal choroidal vasculopathy (PCV) in large colloid drusen (LCD) and to show how switching to intravitreal injection of aflibercept could be considered as a useful treatment of PCV not responsive to other anti-vascular endothelial growth factor (VEGF) injections. Observations A 46-year-old woman was referred to our department with diagnosis of early-onset retinal drusen. Multimodal imaging confirmed the diagnosis of LCD in both eyes, complicated by suggestive PVC in the left eye. Due to the absence of anatomical improvement after 6 intravitreal injections of ranibizumab, the patient was switched and treated by a single injection of aflibercept, showing a complete anatomical and functional recovery. Conclusions and Importance This case suggests progressive development of PCV as a possible late evolution of degenerating LCD. In case of exudative complication, intravitreal aflibercept injection could be considered as a useful treatment, especially in patients who are not responsive to others anti-VEGF injections.
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Affiliation(s)
- Giovanna Vella
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.,Ophthalmology, Department of Surgical, Medical, Molecular, Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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Sacconi R, Borrelli E, Querques L, Bandello F, Querques G. Reply to: Non-Exudative Perifoveal Vascular Anomalous Complex: the Subclinical Stage of Perifoveal Exudative Vascular Anomalous Complex? Am J Ophthalmol 2021; 223:159. [PMID: 33188740 DOI: 10.1016/j.ajo.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022]
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Venkatesh R, Pereira A, Sridharan A. "Hematocrit Sign" in PEVAC Lesion. Asia Pac J Ophthalmol (Phila) 2021; 10:224-225. [PMID: 33793443 DOI: 10.1097/apo.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
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Verhoekx JS, Smid LM, Vermeer KA, Martinez Ciriano JP, Yzer S. Comment on: Nonexudative Perifoveal Vascular Anomalous Complex: The Subclinical Stage of Perifoveal Exudative Vascular Anomalous Complex? Am J Ophthalmol 2021; 223:450-451. [PMID: 33181110 DOI: 10.1016/j.ajo.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
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Tapia Quijada HE, Gómez Perera S, Rodríguez Talavera I, Mantolan Sarmiento C, Rocha Cabrera P, Díaz de Aguilar Osona M, Serrano García M. Focal laser for idiopathic macular telangectasia type 1 refractory to ozurdex, ranibizumab and aflibercept. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:162-166. [PMID: 32507720 DOI: 10.1016/j.oftal.2020.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
We present a case of a woman with idiopathic macular telangiectasia type 1, characterized by the presence of a capillary macroanaeurysm associated with macular edema with a macular star pattern. Several differential diagnoses were proposed, in which the study with a multimodal image was key to clarify the diagnosis. In addition, the various treatments used and their effectiveness are discussed.
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Affiliation(s)
- H E Tapia Quijada
- Servicio de Oftalmología, Sección de Retina, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
| | - S Gómez Perera
- Servicio de Oftalmología, Sección de Retina, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - I Rodríguez Talavera
- Servicio de Oftalmología, Sección de Retina, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - C Mantolan Sarmiento
- Servicio de Oftalmología, Sección de Retina, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - P Rocha Cabrera
- Servicio de Oftalmología, Sección de Retina, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - M Díaz de Aguilar Osona
- Servicio de Oftalmología, Sección de Retina, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - M Serrano García
- Servicio de Oftalmología, Sección de Retina, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
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Verhoekx JSN, Smid LM, Vermeer KA, Martinez Ciriano JP, Yzer S. ANATOMICAL CHANGES ON SEQUENTIAL MULTIMODAL IMAGING IN PERIFOVEAL EXUDATIVE VASCULAR ANOMALOUS COMPLEX. Retina 2021; 41:162-169. [PMID: 32271275 DOI: 10.1097/iae.0000000000002809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a series of 21 patients with perifoveal exudative vascular anomalous complex (PEVAC) and to investigate the anatomical changes over time. METHODS We conducted a retrospective study. Clinical data of consecutive patients, presenting at the Rotterdam Eye Hospital between 2014 and 2019, were analyzed. The data collected included best-corrected visual acuity, fundus photography, optical coherence tomography (OCT), OCT-angiography, fluorescence angiography, and indocyanine green angiography. RESULTS We included 21 patients with a PEVAC lesion with a mean follow-up of 24.3 ± 13.8 months (range, 9-46 months). Patients with PEVAC were on average 75.3 ± 11.1 years (range, 53-90 years). The large perifoveal vascular aneurysmal abnormality was associated with small retinal hemorrhages in six patients and hard exudates in three patients. The PEVAC lesion was associated with intraretinal cystic spaces on OCT in 15 patients. Twelve of 21 patients showed no changes in cystic spaces on OCT during follow-up: 9 patients had stable cystic spaces and 3 patients had no cystic spaces. In contrast, in 9 of 21 patients, we observed changes in cystic spaces on OCT during follow-up. In two patients, cystic spaces appeared during follow-up, and in seven patients, there was a spontaneous resolution of cystic spaces. In three of these seven patients, the PEVAC lesion completely disappeared. Two patients, with stable intraretinal cystic spaces on OCT, were treated with intravitreal injections of anti-vascular endothelial growth factor without improvement. CONCLUSION Perifoveal exudative vascular anomalous complex is an idiopathic perifoveal retinal vascular abnormality that is associated with intraretinal cystic spaces. These intraretinal cystic spaces associated with a PEVAC lesion, and even the PEVAC lesion itself, can have a spontaneous resolution over time.
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Affiliation(s)
| | - Lisette M Smid
- The Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands
| | | | | | - Suzanne Yzer
- The Rotterdam Eye Hospital, Rotterdam, the Netherlands ; and
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Corvi F, Corradetti G, Juhn A, Sadda S. Long-term follow-up of perifoveal exudative vascular anomalous complex treated with intravitreal injections of anti-vascular endothelial growth factor and thermal laser photocoagulation. Am J Ophthalmol Case Rep 2020; 20:100883. [PMID: 33376832 PMCID: PMC7762758 DOI: 10.1016/j.ajoc.2020.100883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/09/2020] [Accepted: 08/16/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To describe the long-term follow-up of a patient with perifoveal exudative vascular anomalous complex (PEVAC) treated initially with intravitreal injections of anti-vascular endothelial growth factor (VEGF) followed by focal thermal laser photocoagulation. OBSERVATIONS A 78 years-old man presented with large, soft drusen in both eyes. Optical coherence tomography and fluorescein angiography revealed the presence of PEVAC in the left eye. The patient was in good general health with no history of diabetes and had no signs of other retinal vascular disease. During the follow-up, the intraretinal fluid accumulation progressively increased and the best-corrected visual acuity (BCVA) dropped from 20/20 to 20/30 over a period of 33 months. As the intraretinal fluid continued to increase and BCVA further decreased to 20/50 despite two intravitreal injections of anti-VEGF, the patient underwent focal thermal laser photocoagulation with a reduction in intraretinal fluid observed 1 month later. Two months after laser, the BCVA increased to 20/25 with complete reabsorption of the intraretinal fluid. Ten months after laser, the BCVA remained stable at 20/25 with no recurrence of intraretinal fluid. CONCLUSIONS AND IMPORTANCE This case illustrates that a PEVAC lesion may remain non-exudative for an extended period of time, but when exudation develops, anti-VEGF therapy may be ineffective requiring the use of thermal laser photocoagulation.
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Affiliation(s)
- Federico Corvi
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital, University of Milan, Milan, Italy
| | - Giulia Corradetti
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Alexander Juhn
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Bacci T, Essilfie JO, Leong BCS, Freund KB. Exudative non-neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2021; 259:1123-34. [PMID: 33242167 DOI: 10.1007/s00417-020-05021-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To describe the clinical and multimodal imaging (MMI) features of age-related macular degeneration (AMD) eyes presenting with intraretinal exudation and no evidence of neovascularization or structural alterations of native retinal vessels. METHODS This was a retrospective review of the MMI and electronic health records for 3 consecutive patients presenting with unilateral exudative non-neovascular age-related macular degeneration. MMI included confocal color fundus photography (CFP), fundus autofluorescence (FAF), fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), swept-source optical coherence tomography angiography (SS-OCTA), and spectral domain optical coherence tomography angiography (SD-OCTA). Dense B-scan OCTA (DB-OCTA) patterns and implemented image post-processing were used to improve spatial resolution in the OCTA analysis and remove projection artifacts. RESULTS Three eyes of 3 patients (1 male and 2 females, ages 72-87) developed intraretinal fluid (IRF) producing retinal edema during regular follow-up for non-neovascular AMD. FA, SS-OCTA, and DB-OCTA demonstrated no evidence of macular neovascularization or discrete retinal vascular abnormalities that could explain the IRF accumulation. Two eyes received intravitreal anti-VEGF therapy and demonstrated prompt resolution of IRF with periodic recurrences over time. CONCLUSION Exudative non-neovascular AMD is a novel clinical phenotype characterized by the presence of non-neovascular intraretinal exudation producing macular edema. Differentiating this condition from other manifestations of AMD requires appropriate use of MMI. Further study is needed to assess the clinical impact and optimal management of exudative non-neovascular AMD.
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Llorente La Orden C, Lopez-Guajardo L, Donate López J. Multimodal imaging of an exudative perifoveal vascular complex. J Fr Ophtalmol 2021; 44:e123-6. [PMID: 33172717 DOI: 10.1016/j.jfo.2020.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/24/2022]
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Henriques J, Pinto F, Rosa PC, Medeiros MD, Reis Cabral D, Henriques S, Nascimento J. Continuous wave milipulse yellow laser treatment for perifoveal exudative vascular anomalous complex-like lesion: A case report. Eur J Ophthalmol 2020; 32:NP119-NP124. [PMID: 33092428 DOI: 10.1177/1120672120966564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Perifoveal exudative vascular anomalous complex (PEVAC) is an underdiagnosed macular entity. A striking feature of this entity is the unresponsiveness to anti-VEGF treatment. Continuous wave milipulse yellow laser 577 nm (CWMYL-577) has a high absorption peak for oxyhaemoglobin, which allows for low power density use. PURPOSE To report a case of a PEVAC-like lesion unresponsive to anti-VEGF and corticosteroids, successfully treated with a single session of minimally invasive focal laser, using CWMYL-577. METHODS A diabetic patient with a symptomatic PEVAC-like lesion in the right eye, presented with decreased vision (20/100) and cystoid edema that had persisted for the last 18 months, despite multiple intraocular injections of anti-VEGF and long acting corticosteroids. Three spots of low power density CWMYL-577 (100 mW, 25 ms and 100 µm, using lens with no amplification factor) over the lesion were successfully performed in one laser session. One month and three months after the laser procedure, a gradual decrease of edema and lipid exudates was observed and at a 6-month follow-up, the retina had recovered its normal anatomy with visual acuity of 20/20 that have persisted for 4 years after treatment. CONCLUSIONS Minimal invasive focal laser using the CWMYL-577 can be considered an effective therapeutic strategy for symptomatic nonresponding PEVAC-like lesion in patients with DM without DR.
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Affiliation(s)
- José Henriques
- Lisbon Retina Institute, Lisbon, Portugal.,Instituto de Oftalmologia Doutor Gama Pinto, Lisboa, Portugal
| | | | - Paulo Caldeira Rosa
- Lisbon Retina Institute, Lisbon, Portugal.,Instituto de Oftalmologia Doutor Gama Pinto, Lisboa, Portugal
| | | | | | - Susana Henriques
- Professor Doutor Fernando Fonseca Hospital, Amadora, Lisboa, Portugal
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Sacconi R, Borrelli E, Sadda S, Corradetti G, Freund KB, Yannuzzi LA, Souied E, Capuano V, Sarraf D, Querques L, Bandello F, Querques G. Nonexudative Perifoveal Vascular Anomalous Complex: The Subclinical Stage of Perifoveal Exudative Vascular Anomalous Complex? Am J Ophthalmol 2020; 218:59-67. [PMID: 32360340 DOI: 10.1016/j.ajo.2020.04.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the pre-exudative stage of exudative perifoveal vascular anomalous complex (ePVAC), referred to as nonexudative PVAC (nePVAC). DESIGN Retrospective noncomparative case series. METHODS Patients diagnosed with nePVAC were identified at 4 retina referral centers worldwide. Multimodal retinal imaging, including structural optical coherence tomography (OCT) and OCT-angiography (OCT-A), were performed at baseline and follow-up visits. RESULTS Six eyes (6 patients, mean 75 ± 10 years of age) were included. Unrelated chorioretinal diseases were diagnosed in the affected eyes in 5 of 6 cases. At baseline, nePVAC is characterized by microvascular abnormalities featuring an isolated, perifoveal, large intraretinal aneurysm surrounded by capillary rarefaction at OCT-A examination, without any sign of exudation with structural OCT, and without visual impairment. Four patients were followed for a mean of 21 ± 14 months. During the follow-up, 3 of 4 eyes (75%) developed signs of exudation after a mean of 15 ± 9 months, associated with metamorphopsia and visual decline at the time of exudation. Best-corrected visual acuity decreased from 20/25 to 20/40 Snellen equivalent (P = .035) and central macular thickness increased from 268 ± 27 μm to 339 ± 65 μm (P = .145). Three patients were treated with 2.3 ± 0.6 intravitreal injections of anti-vascular endothelial growth factor without significant improvement of best-corrected visual acuity or macular edema. CONCLUSIONS nePVAC may represent the subclinical pre-exudative stage of ePVAC, notable for an absence of exudation or visual impairment. nePVAC and ePVAC should be considered as part of the same spectrum, namely PVAC. Typically, nePVAC develops signs of exudation over time, causing metamorphopsia and visual decline and therefore these lesions warrant continued close monitoring with multimodal retinal imaging.
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Sacconi R, Borrelli E, Bandello F, Querques G. Perifoveal exudative vascular anomalous complex in a highly myopic eye. Ther Adv Ophthalmol 2020; 12:2515841420947930. [PMID: 32964194 PMCID: PMC7488887 DOI: 10.1177/2515841420947930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/13/2020] [Indexed: 11/21/2022] Open
Abstract
‘Perifoveal Exudative Vascular Anomalous Complex’ (PEVAC) is a perifoveal, unilateral, isolated, perifoveal aneurysm, in otherwise healthy patients. Here, we report a case of PEVAC in a highly myopic eye of a 86-year-old woman affected by a visual decline in the right eye (best-corrected visual acuity of 20/100). She had no other relevant past conditions and/or ocular impairment. Fundus examination in the right eye showed myopic chorioretinal degeneration with a concomitant PEVAC. Structural optical coherence tomography (OCT) showed a round lesion with a hyperreflective wall associated with intraretinal cystic spaces. OCT-angiography nicely disclosed an isolated large aneurysmal retinal dilation featuring the PEVAC with detectable flow in superficial capillary plexus, deep capillary plexus, and avascular slab. This case highlights the importance of discerning between different vascular disorders of the macula, in order to be able to offer the right treatment and/or follow-up to the patient.
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Affiliation(s)
- Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
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Heine F, Schick JF, Lang GE. OCT Angiographic Findings in Retinal Angiomatous Proliferation. Klin Monbl Augenheilkd 2020; 238:815-822. [PMID: 32869242 DOI: 10.1055/a-1219-7875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND OCT angiography (OCT-A) allows non-invasive blood flow registration of the retina and choroid. In contrast to fluorescein angiography (FA), no dye has to be administered. The OCT-A also provides depth-selective information. OCT-A and FA were compared in patients with neovascular age-related macular degeneration (AMD) with retinal angiomatous proliferation (RAP) stage 1. In stage 1, the neovascularizations are intraretinal. In contrast to the two-dimensional total image of the FA, the OCT-A allows a depth-selective display of the individual retinal layers. In this way, a conclusion can be drawn about the place of origin of the RAP. PATIENTS AND METHODS Three patients with neovascular AMD and RAP stage 1 were included. They were examined with OCT (ZEISS CIRRUS HD-OCT 5000, Carl Zeiss Meditec, Inc., Dublin, USA), OCT-A (ZEISS AngioPlex OCT-Angiography) as well as FA (HRA2, Heidelberg Engineering) between January 2016 and March 2019. A complete ophthalmological examination was performed. A qualitative analysis of the OCT-A images (3 × 3 and 6 × 6 mm) and the FA images was carried out. Leaks in the FA were compared with the en-face images of the OCT-A followed by a depth-selective assignment using the corresponding B-scans of the OCT-A. RESULTS It was one woman and two men aged 66 - 89 years. The visual acuity was 0.4 in the first, 0.5 p in the second and 0.8 in the third patient. The diagnosis of RAP stage 1 could be made both in the OCT, the FA and the OCT-A. All patients showed macular edema in the OCT. The FA showed selective hyperfluorescence in the early phase and fluorescein extravasation in the late phase. In OCT-A, the blood flow in all patients could be shown in the hyperreflective structure of the RAP in the B-scan. The first patient showed two RAP lesions in the FA, which were in the deep vascular plexus in the OCT-A. In the second patient, three RAP lesions were found in the FA, and a total of five RAP lesions in the OCT-A. One could be located in the superficial and deep vascular plexus, four in the deep vascular plexus. The third patient showed one RAP lesion in the FA as well as in the OCT-A, which could be assigned to the superficial vascular plexus. CONCLUSION The OCT-A is well suited for the diagnosis of RAP stage 1. In the present cases, the diagnosis in the OCT-A could be made as clearly as by FA. A major advantage of the OCT-A results from the non-invasive character and the depth selectivity. The RAP 1 lesions could be assigned to both the superficial and the deep vascular plexus. Depth selection is not possible with the FA due to the summary picture.
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Affiliation(s)
- Felix Heine
- Klinik für Augenheilkunde, Universitätsklinikum Ulm
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Silva N, Marta A, Baptista P, Furtado MJ, Lume M. Optical Coherence Tomography Findings (SD-OCT and OCTA) in Early-Stage Type 3 Neovascularization. Case Rep Ophthalmol 2020; 11:493-499. [PMID: 32999681 PMCID: PMC7506272 DOI: 10.1159/000509139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022] Open
Abstract
A 76-year-old male presented with a small hyperreflective density in the outer nuclear layer with subtle retinal pigment epithelium (RPE) elevation and few intraretinal cysts on spectral-domain optical coherence tomography (SD-OCT). Optical coherence tomography angiography (OCTA) confirmed the presence of a tuft-shaped intraretinal neovascular lesion. SD-OCT performed 2 months before showed a smaller RPE elevation at the same location without intraretinal fluid. A 79-year-old male presented with a small hyperreflective density in the outer retina surrounded by scant intraretinal fluid on SD-OCT and a bright vessel on OCTA, suggesting early-stage type 3 neovascularization. SD-OCT performed 2 months before showed a smaller hyperreflectivity at the same location, without intraretinal fluid. An 84-year-old female presented with hyperreflective foci in the outer retina overlying a serous pigment epithelium detachment (PED) with focal RPE disruption on SD-OCT. SD-OCT performed 2 months before showed the same hyperreflective lesion associated with a shallower PED. No neovascular lesions were found on OCTA after six injections of bevacizumab. To conclude, careful evaluation of SD-OCT allows for early detection of type 3 neovascularization at a pre-exudative stage. OCTA may be useful in confirming the presence of intraretinal neovascular lesion and monitoring response to anti-vascular endothelial growth factor agents.
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Affiliation(s)
- Nisa Silva
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Ana Marta
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Pedro Baptista
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Maria João Furtado
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Miguel Lume
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Fernández-Vigo JI, Burgos-Blasco B, Dolz-Marco R, Jiménez-Santos M, López-Guajardo L, Donate-López J. Atypical perifoveal exudative vascular anomalous complex (PEVAC) with multifocal and bilateral presentation. Am J Ophthalmol Case Rep 2020; 18:100717. [PMID: 32368691 PMCID: PMC7184128 DOI: 10.1016/j.ajoc.2020.100717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/26/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To report an unusual case of multifocal and bilateral perifoveal exudative vascular anomalous complex (PEVAC) lesions in an otherwise healthy patient. Observations A 62-year-old male with complaints of long-term progressive blurred vision in both eyes. There was no history of diabetes, arterial hypertension or inflammatory disease. Best-corrected visual acuity was 75 and 80 letters in his right eye (OD) and left eye (OS) respectively. Fundus examination showed three perifoveal isolated large aneurysmal lesions in his OD and an additional one in his OS, associated with smaller microaneurysms, haemorrhages and intraretinal exudation. On optical coherence tomography PEVAC appeared as a round lesions with a hyperreflective wall and lumen containing variably reflective material, typically surrounded by intraretinal fluid. Dye-based angiography demonstrated three and one well-defined large hyperfluorescent aneurysmal lesions in his OD and OS respectively, with no leakage. The optical coherence tomography angiography images showed flow signal within the intraretinal aneurysmal lesions. No anomalous flow signal in the outer retina and choriocapillaris was present. After one bilateral anti-vascular endothelial growth factor intravitreal injection no anatomical or functional improvement was observed, and no changes in the lesions or visual acuity were observed at 6 months follow-up. Conclusions and importance We describe an atypical case of PEVAC, an uncommon and poorly known macular disorder, with bilateral presentation and multifocal lesions in one eye. To our knowledge, this is the first reported case of bilateral PEVAC lesions. Hence, PEVAC should be included in the differential diagnosis of bilateral perifoveal aneurysmal lesions with macular edema.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Bárbara Burgos-Blasco
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | | | - María Jiménez-Santos
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - Lorenzo López-Guajardo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - Juan Donate-López
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
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Banda HK, Dang S, Rothman RJ. Perifoveal Exudative Vascular Anomalous Complex With Suspended Scattered Particles in Motion. Ophthalmic Surg Lasers Imaging Retina 2020; 50:796-800. [PMID: 31877226 DOI: 10.3928/23258160-20191119-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/11/2019] [Indexed: 11/20/2022]
Abstract
Perifoveal exudative anomalous complex (PEVAC) is an uncommon entity that occurs in isolation or in association with retinal vascular disorders. The authors describe a case of a 47-year-old man presenting with a central scotoma in the left eye found to have an isolated PEVAC. Fundus photography, optical coherence tomography (OCT), and intravenous fluorescein angiography were collected. OCT angiography of the lesion revealed suspended scattered particles in motion, a newly described finding in exudative macular retinopathies. The authors describe the first case of PEVAC with angiographic evidence of suspended scattered particles in motion. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:796-800.].
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Sacconi R, Battista M, Borrelli E, Miere A, Corbelli E, Capuano V, Querques L, Souied EH, Bandello F, Querques G. OCT-A characterisation of recurrent type 3 macular neovascularisation. Br J Ophthalmol 2020; 105:222-226. [DOI: 10.1136/bjophthalmol-2020-316054] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/15/2020] [Accepted: 03/19/2020] [Indexed: 11/04/2022]
Abstract
PurposeTo investigate optical coherence tomography angiography (OCT-A) findings in recurrent type 3 macular neovascularisation (MNV).MethodsIn this retrospective cohort study, consecutive patients with type 3 MNV secondary to age-related macular degeneration underwent OCT-A at three different time points: baseline, after anti-vascular endothelial growth factor treatment with complete resolution of the exudative signs (ie, non-exudative stage) and at the recurrence of exudation (ie, recurrence stage). Demographics and clinical findings were analysed, including OCT-A features of type 3 MNV recurrence.ResultsTwelve eyes (12 patients, mean age 78±7 years) were included. Using OCT-A, at baseline all type 3 MNVs showed the presence of detectable flow downgrowing from the deep vascular complex (DVC) to the retinal pigment epithelium (RPE)/sub-RPE space. 6/12 eyes (50%) showed anomalous flow under the RPE, while the other 6 eyes showed flow reaching the RPE without anomalous flow in the sub-RPE space. At the non-exudative stage (after treatment), BCVA and CMT significantly improved (p=0.004 and p=0.036), and flow inside the retinal lesions reduced; interestingly the connection to the RPE/sub-RPE space regressed. At the time of recurrence, all type 3 MNVs showed the presence of intra/sub-retinal exudation with restoration of the flow deepening from the DVC to the RPE/sub-RPE space.ConclusionsDetectable flow deepening from the DVC to the RPE/sub-RPE space using OCT-A is mandatory to have a new exudation secondary to recurrent type 3 MNV. Early detection of type 3 MNV recurrence by OCT-A characterisation may prompt retreatment and potentially prevent progression to late stages of the disease.
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Sacconi R, Corbelli E, Borrelli E, Capone L, Carnevali A, Gelormini F, Querques L, Bandello F, Querques G. Choriocapillaris flow impairment could predict the enlargement of geographic atrophy lesion. Br J Ophthalmol 2020; 105:97-102. [PMID: 32201374 DOI: 10.1136/bjophthalmol-2019-315800] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 11/04/2022]
Abstract
AIM To analyse the choriocapillaris (CC) flow status in the area that subsequently showed geographic atrophy (GA) expansion secondary to age-related macular degeneration (AMD) during 1-year follow-up, matching optical coherence tomography angiography (OCT-A) and fundus autofluorescence (FAF). METHODS In this prospective longitudinal observational study, 30 eyes of 20 consecutive patients with GA secondary to AMD (mean age 75.5±7.4 years) were included. All patients underwent OCT-A and FAF at baseline and 1-year follow-up. Main outcome measures included analysis of perfusion density (PD) in the 'area surrounding GA margin' (between the GA border and 500 µm distance) in comparison with the 'control area' (area outside the 500 µm line), and of the 'expansion area' (area that subsequently developed GA expansion during 1-year follow-up). RESULTS During the 1-year follow-up, visual acuity significantly decreased from 0.34±0.38 Logarithm of the Minimum Angle of Resolution (LogMAR) to 0.39±0.40 LogMAR (p<0.001), and mean GA area increased from 6.82±5.47 mm2 to 8.76±6.28 mm2 (p<0.001). CC PD of the area surrounding the GA margin revealed a significant flow impairment compared with control area (PD 0.679±0.076 and 0.734±0.057, respectively (p<0.001)). Furthermore, the PD of the expansion area showed a greater CC flow impairment in comparison to the remaining area surrounding GA margin (p<0.001). CONCLUSIONS We reported a greater CC impairment in the area that subsequently developed GA expansion, suggesting that the CC flow impairment could predict the enlargement of GA lesion. The CC impairment could be considered as a new a risk factor for GA progression and a biomarker to be measured to determine efficacy of new interventions aiming to slow progression of GA.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eleonora Corbelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Capone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Adriano Carnevali
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Ophthalmology, University Hospital "Magna Graecia", Catanzaro, Italy
| | - Francesco Gelormini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lea Querques
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy .,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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