The Rap Study, Report 5: Rediscovering Macular Neovascularization Type 3

Najeeb, Bilal Haj; Deák, Gábor; Mylonas, Georgios; Sacu, Stefan; Gerendas, Bianca S.; Schmidt‐Erfurth, Ursula

doi:10.1097/iae.0000000000003330

Cited by 15 publications

(31 citation statements)

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“…Microvascular anomalies in eyes with neovascular and non-neovascular AMD include capillary dilations and telangiectasia that are associated with locally increased VEGF expression. 17,59-61 A recent study showed that 19/94 eyes with type 3 MNV exhibited an asymptomatic precursor stage on OCT. 44 Because lack of exudation and non-progression to type 3 MNV in our case might result from VEGF suppression, 62 longitudinal imaging is required to definitively place DRAMA in the progression sequence of type 3 MNV.…”

Section: Discussionmentioning

confidence: 90%

“…In two anti-VEGF treated eyes of one patient with neovascular AMD, we compare longitudinal multimodal clinical imaging and histology of type 3 MNV and DRAMA ( Table 2, Table 4 ). Although one patient, the clinical and imaging characteristics are typical of multifocal type 3 MNV, including bilaterality (55% of cases) 44 and absence of type 1 MNV. 11-13, 44, 45 Type 3 MNV is distinguished by intraretinal origin, 1, 2, 46 frequent near-term bilateral involvement, 7-9 and significant choroidal thinning with reduced perfusion.…”

Section: Discussionmentioning

confidence: 92%

“…Although one patient, the clinical and imaging characteristics are typical of multifocal type 3 MNV, including bilaterality (55% of cases) 44 and absence of type 1 MNV. 11-13, 44, 45 Type 3 MNV is distinguished by intraretinal origin, 1, 2, 46 frequent near-term bilateral involvement, 7-9 and significant choroidal thinning with reduced perfusion. 47, 48 Patients with type 3 MNV are older at initial diagnosis than patients with type 1 MNV.…”

Section: Discussionmentioning

confidence: 92%

“…In a recent study of 25 eyes with type 3 MNV most cases exhibited on OCT an asymptomatic precursor stage. 62 Non-neovascular microvascular anomalies associated with locally increased VEGF expression 63, 64 include capillary dilations and telangiectasia in eyes with neovascular AMD and non-neovascular AMD. 18, 63, 65 None of our 4 DRAMA lesions involved the SCP on OCTA and histology, and no significant intraretinal fluid was detectable on OCT over time.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Histology of type 3 macular neovascularization and microvascular anomalies in treated age-related macular degeneration: a case study

Berlin

Cabral

Chen

et al. 2022

Preprint

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Histology of type 3 macular neovascularization and microvascular anomalies in treated age-related macular degeneration: a case study

Berlin

Cabral

Chen

et al. 2022

Preprint

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“…If not punctually recognized and treated, Type 3 MNV can rapidly advance toward development of macular atrophy 11 and fibrotic scars. 12 Therefore, it is paramount to discover new multimodal imaging biomarkers to maximize the probability of detecting effectively treatable precursor lesions.…”

mentioning

confidence: 99%

Optical Coherence Tomography Angiography Characterization of Evolving Lesions in Fellow Eyes of Exudative Type 3 Macular Neovascularization Patients

Sacconi

Forte

Capuano

et al. 2022

Retina

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Purpose: To investigate fellow eyes of newly diagnosed unilateral exudative Type 3 (T3) macular neovascularization (MNV) patients by assessing the presence and progression of a preclinical neovascular component during a 3-year follow-up.Methods: This is a longitudinal study involving three retinal referral centers. Patients affected by unilateral exudative treatment-naive T3 MNV were enrolled.Results: Twenty-four eyes of 24 patients (79 ± 6 years old) were enrolled. Nine eyes (37%) displayed a nonexudative T3 MNV at baseline that developed exudation after a mean of 9 ± 9 months. Fifteen eyes that did not display a nonexudative Type 3 MNV at baseline. Five eyes (21%) did not display neovessels at baseline, but showed a nonexudative T3 after 13 ± 9 months, and exudation after 8 ± 3 months. Five eyes (21%) developed active exudative T3 MNV after 23 ± 9 months, with no detectable nonexudative stage at baseline. Five eyes (21%) did not show MNV, but progressed to geographic atrophy by 36 months of follow-up. Overall, T3 MNV in the fellow eye accounted for 79%, all developing exudation over 3 years of follow-up. Conclusion:The occurrence of a nonexudative T3 MNV is a frequent event in the fellow eye of patients newly diagnosed with unilateral exudative T3 MNV and it precedes the development of exudation over 3 years (prevalence of 37% and cumulative incidence of 79%). Optical coherence tomography angiography approach may be used to perform an early diagnosis and treatment of patients with T3 MNV.

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Optical Coherence Tomography Angiography and Corresponding Histology—Reply

2023

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COMMENT & RESPONSEIn Reply Thank you very much for your interest in our recent publication. 1 We are happy to answer each of your questions in order.1. An injection was administered 8 weeks before optical coherence tomography angiography (OCTA) imaging and 8 weeks before date of death in the right eye. 2. Eight injections at about 8-week intervals were administered between OCTA imaging and date of death over 16 months. Before undergoing OCTA imaging, the patient had received 28 intravitreal injections over more than 3.5 years, indicating a chronic lesion with chronic changes. Substantial changes of the macular neovascularization structure in such a chronic complex are not likely. 3. We agree that connections between the deep capillary plexus (DCP) and the choriocapillaris are associated with advanced stages of disease. Choroidal contributions have been confirmed in surgical specimens 2 and in clinical imaging studies of treated eyes. 3 Thus we stated: "Our current findings do not exclude such a connection in general or in other cases." 1 We could have also said (but did not) that we did not see DCPoriginating vessels penetrate through basal laminar deposit (BLamD) and enter the sub-RPE-basal laminar (BL) space. As cited in the letter to the editor, Sacconi et al 4 described how DCP-originating flow signal extends past the RPE (and also BLamD) during periods of exudation. 4. Figure 1B of our article 1 shows a type 3 lesion with flow signal, positioned over calcified drusen that masquerade as a double layer sign. We chose to detail this lesion, and others in this case, in a separate manuscript. The type 3 lesion in Figure 1B spans a large area. As we state as a limitation, 1 our use of stepped sections may have missed connections between the retinal and choroidal circulations, and as mentioned above, may have also missed connections between the DCP and sub-RPE-BL space. Lack of serial sections is a trade-off we accepted in using epoxy resin embedding for high-resolution light microscopy covering a large area. However, in all analyzed tissue sections of the Figure 1B lesion, both BLamD and the Bruch membrane were intact. Furthermore, we did not see OCTA flow signal in the sub-RPE-BL space under this lesion, perhaps because we used volumetric projection artifact removal. This technique should reduce the chance of seeing spurious signal directly under type 3 neovascularization. This is especially important for accurate localization of flow in instances where the RPE-BL is not elevated by a hyporeflective structure, such as sub-RPE fluid or a calcific nodule. Sacconi et al, 4 who reported many treatment-naive eyes with flow signal in the sub-RPE-BL space, at the same time mentioned lack of pro-

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The Rap Study, Report 5: Rediscovering Macular Neovascularization Type 3

Cited by 15 publications

References 31 publications

Histology of type 3 macular neovascularization and microvascular anomalies in treated age-related macular degeneration: a case study

Histology of type 3 macular neovascularization and microvascular anomalies in treated age-related macular degeneration: a case study

Optical Coherence Tomography Angiography Characterization of Evolving Lesions in Fellow Eyes of Exudative Type 3 Macular Neovascularization Patients

Optical Coherence Tomography Angiography and Corresponding Histology—Reply

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