Multimodal Evaluation of the Fellow Eye of Patients with Retinal Angiomatous Proliferation

Abstract

Introduction: We conducted a multimodal, cross-sectional evaluation. Methods: Eyes were divided into 4 study groups: controls, early/intermediate age-related macular degeneration (AMD), fellow eyes of retinal angiomatous proliferation (RAP), and RAP eyes. Patients were evaluated with spectral-domain optical coherence tomography (OCT), enhanced depth imaging-OCT, and OCT angiography (OCTA). OCTA images were processed to generate maps of the vessel density and perfusion density of the superficial and deep retinal layers (SRL and DRL) and the choriocapillaris level (CL). The thickness of the outer nuclear layer and choroid was manually assessed. Results: We included 135 eyes of 100 patients (51 controls, 30 AMD, 42 RAP, and 12 fellow eyes). The fellow eyes showed a significantly lower vascular perfusion of the SRL, DRL, and CL (p < 0.02) than the early/intermediate AMD and control eyes did. Similarly, RAP eyes presented a lower vascular perfusion of the DRL and CL (p < 0.05). Besides, structural analyses of the fellow eyes and RAP eyes revealed a significantly higher prevalence of macular pigmentary changes, atrophy of the retinal pigment epithelium, hyperreflective “clumps” above flat drusen, amongst others, than early/intermediate AMD and control eyes (p < 0.05). Conclusion: We present the first report on the OCTA analysis of the fellow eye of patients with RAP. The reduced perfusion density and vessel density observed contributes, in association with clearly defined structural changes, to a wider characterization of RAP as a distinctive phenotype.

Clinical Pathological Features and Current Animal Models of Type 3 Macular Neovascularization

“…The presence of small retinal hemorrhages, macular soft drusen, and RPD is highly predictive of MNV3, and especially intraretinal hemorrhages are a distinguishing feature from typical CNV ( Yannuzzi et al, 2001 ; Kim et al, 2014 ; Tsai et al, 2017 ). RPE atrophy, GA, and focal hyperpigmentation are common features in the fellow eyes of MNV3 ( Martins et al, 2018 ). RPD and a large area of soft drusen are risk factors for bilateral MNV3 (Miki Sawa et al, 2014 ; Marques et al, 2015 ; Chang et al, 2016 ).…”

The role of quantitative deep capillary plexus in the pathogenesis of type 3 macular neovascularization: an optical coherence tomography angiography study

“…Martins et al [ 6 ] also noticed a significantly lower vascular perfusion of the DCP in patients with RAP.…”

“…In the last years, several studies performed to understand the pathogenesis of type 3 MNV, supported the intraretinal origin, highlighted early stages' features of type 3 NV, and demonstrated the presence of reticular pseudodrusen as a risk factor to the development of type 3 MNV [5][6][7][8][9].…”

Chorioretinal thickness and retinal pigment epithelial degeneration of fellow eyes in patients with unilateral neovascular age-related macular degeneration with subretinal drusenoid deposits

“…Several studies have reported fellow eye characteristics of AMD with type 3 neovascularization, suggesting they include atrophy of the RPE, the presence of reticular pseudodrusen, increased numbers of drusen, hyper-reflective foci, and reduced retinal and choroidal blood flow [6,33,39,40]. In this study, we classified RPE features concisely to assess the status of eyes with certain retina, GCIPL, and choroidal thickness values intuitively.…”