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OUTER RETINAL TUBULATION MAY RESULT FROM FIBROSED TYPE 2 NEOVASCULARIZATION: Clinical Observations and Model of
Ernst Janse van Rensburg1, Christina L Ryu1,2,3, Emmanouil Rampakakis4
1Department of Ophthalmology, McGill University Health Centre, Montreal, Quebec, Canada.
Type 2 macular neovascularization (MNV) and associated fibrosis are key predictors of outer retinal tubulation (ORT) formation in patients with exudative macular degeneration. This finding highlights the role of fibrosis in ORT development.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Macular Degeneration
Background:
- Exudative age-related macular degeneration (AMD) involves choroidal neovascularization (CNV).
- Outer retinal tubulation (ORT) is a recently described phenomenon in AMD, but its pathogenesis is not fully understood.
Purpose of the Study:
- To investigate the role of Type 2 macular neovascularization (MNV) and subsequent subretinal fibrosis in the development of outer retinal tubulation (ORT).
Main Methods:
- Retrospective cohort study of 134 patients with stabilized inactive exudative AMD treated with anti-VEGF agents.
- Analysis of baseline fluorescein angiography and optical coherence tomography (OCT) images.
- Classification of MNV by type and size, and assessment for ORT development on serial OCT scans.
Main Results:
- ORT was observed in 38% of eyes (55/144).
- Eyes with Type 2 MNV had a significantly higher incidence of ORT (61%) compared to eyes with pure Type 1 MNV (6.7%).
- Multivariate analysis identified Type 2 MNV, larger MNV size, and subretinal fibrovascular material as significant predictors of ORT formation. Fibrosis was found underlying ORT in 70.9% of cases.
Conclusions:
- Type 2 macular neovascularization at presentation is a strong predictor of ORT formation.
- Subretinal fibrosis frequently underlies ORT, suggesting its contraction may play a crucial role in ORT pathogenesis.
- These findings advance the understanding of ORT development in the context of exudative AMD.
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