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Types of choroidal neovascularisation in newly diagnosed exudative age-related macular degeneration

¹ Centre Ophtalmologique d’Imagerie et de Laser, Paris, France
² Centre Hospitalier Universitaire, Dijon, France
³ Centre d’Imagerie et de Laser, Nice, France
⁴ Centre d’Imagerie et de Laser, Lambersart, France
⁵ Centre Hospitalier Universitaire, Bordeaux, France
⁶ Pfizer, Paris, France
⁷ Biostatem Company, Nîmes, France
⁸ Centre Hospitalier Universitaire, Nantes, France
⁹ Inserm U593, Bordeaux, France; Université Victor Segalen, Bordeaux, France

Correspondence to:
Salomon Y Cohen, Centre Ophtalmologique d’Imagerie et de Laser, 11 Rue Antoine Bourdelle, 75015 Paris, France; sycohen{at}club-internet.fr

Aim: To describe the types and location of choroidal neovascularisation (CNV) in exudative age-related macular degeneration (AMD), including vascularised pigment epithelial detatchments (PED), and most recently described subtypes, such as retinal choroidal anasmostosis, also termed "retinal angiomatous proliferation" (RAP).

Methods: Prospective multicentre consecutive descriptive case series. A total of 207 consecutive cases of newly diagnosed exudative AMD undergoing fluorescein angiography (FA) were recruited by 7 French referral hospital-based or private centres. Indocyanine green angiography (ICG) also was performed, when judged necessary by investigators. Types and location of CNV were classified by two independent experts and adjudicated by a third when discordant.

Results: All patients had FA, while ICG was performed in 50% of subjects. A total of 17.6% had classic CNV only, 5.4% and 8.3% had predominantly and minimally classic CNV, respectively. Occult CNV could be classified in occult CNV without PED (32.7%) and occult CNV with PED, ie, vascularised PED (23.9%). RAP was observed in 15.1% of cases, and accounted for 30% of vascularised PED. In 5.8% of the cases there was haemorrhagic AMD and 4.8% had fibrovascular scars. Lesions were mainly subfoveal (80%). Agreement between the centre’s ophthalmologist and the final validated expert classification was moderate ( = 0.52 for location and 0.59 for type of lesion).

Conclusion: This study confirms that newly diagnosed cases of exudative AMD are mainly occult and subfoveal. RAP appeared as a common lesion in patients with newly diagnosed exudative AMD.

Abbreviations: AMD, age-related macular degeneration; CNV, choroidal neovascularisation; FA, fluorescein angiography; ICG, indocyanine green angiography; PED, pigment epithelial detatchments; RAP, retinal angiomatous proliferation; VEGF, vascular endothelial growth factor

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