Clinical implication of aberrant choroidal feeding artery in type 1 macular neovasculopathy

Type 1 macular neovascularization (MNV) is the most common type of MNV located in the sub-retinal pigment epithelium (RPE). Although type 1 MNV harbors significant clinical variabilities, the underlying pathomechanism has not been fully elucidated yet. The present study evaluated the characteristics of the choroidal feeding artery in 51 eyes with type 1 MNV using a multimodal imaging composite. In most cases (88.2%), a clear, visible connection between the MNV and choroidal artery was not confirmed. A seamless connection between the MNV and the underlying choroidal feeding artery was found in six of 51 eyes (11.8%). Patients with this aberrant choroidal feeding artery showed large pigment epithelial detachments (PED; P < 0.001) and sub-RPE deposits (P < 0.001) more frequently. Patients with aberrant choroidal feeding arteries achieved a dry macula of a similar percentage (P = 0.680) with more frequent anti-vascular endothelial growth factor injections (P = 0.005) and a switch to brolucizumab (P = 0.042) during a similar follow-up period (P = 0.305). Type 1 MNV with aberrant choroidal feeding arteries showed distinct characteristics from unimpeded blood flow (Large PED and sub-RPE deposits), suggesting that the aberrant choroidal arteries serve not only as a source of blood flow but also contribute to the development of MNV by arteriogenesis.