Combined cases of polypoidal choroidal vasculopathy and typical age-related macular degeneration
Ichiro Maruko1, Tomohiro Iida, Masaaki Saito
1Department of Ophthalmology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1247, Japan. imaruko@fmu.ac.jp
Background:
When we classified neovascular exudative age-related macular degeneration (AMD) into three types of polypoidal choroidal vasculopathy (PCV), typical AMD, and retinal angiomatous proliferation (RAP) in our previous study, we reported 5.5% had the combined cases, such as one eye had PCV and the other eye had typical AMD. We examined the clinical characteristics of these combined cases in the current study.
Methods:
All cases underwent fluorescein and indocyanine green angiography (FA and ICGA) at the initial examination. All PCV cases were diagnosed definitively based on characteristic aneurysmal lesions seen on ICGA. Follow-up examinations also were conducted to determine whether polypoidal lesions had developed in the eyes with typical AMD.
Results:
Among 349 patients with neovascular AMD, 20 (5.7%) had one eye with PCV and the other eye with typical AMD. The average age was 73 years. The mean best-corrected visual acuity levels at the initial examination in eyes with PCV and typical AMD were 0.20 and 0.43, respectively (p=0.09). All subgroups of classic and occult CNV were observed in the eyes with typical AMD on FA. During the follow-up period (average, 21.7 months), PCV developed in ten eyes with typical AMD at the initial examination.
Conclusions:
Although some cases might include different stages of progression or probable cases of PCV, the combined cases in which one eye has PCV and the other eye has typical AMD suggest that those clinical entities are not independent and possibly overlap.
Insights
Combined cases of polypoidal choroidal vasculopathy (PCV) and typical age-related macular degeneration (AMD) suggest these conditions may overlap. Further research is needed to understand the relationship between PCV and typical AMD progression.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Macular Degeneration
Background:
- Age-related macular degeneration (AMD) is a leading cause of vision loss.
- Neovascular AMD can manifest as polypoidal choroidal vasculopathy (PCV), typical AMD, or retinal angiomatous proliferation (RAP).
- Previous studies identified combined AMD cases, where one eye exhibits PCV and the other typical AMD.
Observation:
- This study investigated 20 patients (5.7%) with one eye diagnosed with PCV and the other with typical AMD.
- Initial best-corrected visual acuity differed between PCV (0.20) and typical AMD (0.43) eyes.
- Fluorescein and indocyanine green angiography (FA and ICGA) were used for diagnosis and monitoring.
Findings:
- During a mean follow-up of 21.7 months, ten eyes initially diagnosed with typical AMD developed PCV.
- Typical AMD eyes exhibited both classic and occult choroidal neovascularization (CNV) on FA.
- The average age of patients with combined AMD types was 73 years.
Implications:
- The findings suggest that PCV and typical AMD are not distinct entities and may represent overlapping stages of the same disease.
- Understanding this overlap is crucial for accurate diagnosis and treatment strategies in neovascular AMD.
- Further investigation into the progression and potential transformation between PCV and typical AMD is warranted.
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