Neovascular and Nonneovascular Subretinal Fluid Associated with Angioid Streaks: Comparative Imaging Analysis with Long-Term Follow-Up
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Published on: January 21, 2018
Alessandro Feo1, Elodie Bousquet2, Andrea Coletto2
1Retina Division, Stein Eye Institute, University of California of Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Purpose:
To characterize the multimodal imaging features and long-term visual and structural outcomes of subretinal fluid (SRF) associated with angioid streaks (AS) and to compare neovascular and nonneovascular phenotypes.
Design:
Multicenter retrospective cohort study.
Participants:
Fifty-three eyes of 43 patients with AS-associated SRF.
Methods:
Medical records of patients with AS and SRF were retrospectively reviewed across multiple centers. Clinical and multimodal imaging data, including color fundus photography, fundus autofluorescence, OCT, and OCT angiography, were analyzed at baseline and final follow-up. Eyes were classified as neovascular or nonneovascular based on evidence of choroidal neovascularization (CNV). OCT parameters included central macular thickness (CMT), subfoveal choroidal thickness (SFCT), SRF dimensions, and outer retinal integrity. Longitudinal visual and anatomic outcomes were compared between groups.
Main Outcome Measures:
Visual acuity (VA), SRF evolution, OCT structural changes, development of complete retinal pigment epithelium (RPE) and outer retinal atrophy (cRORA), and comparison of outcomes between neovascular and nonneovascular SRF phenotypes.
Results:
Mean baseline VA was 0.36 ± 0.34 logarithm of the minimum angle of resolution (LogMAR; ∼20/45 Snellen). Choroidal neovascularization was identified in 37 eyes (69.8%), whereas 16 eyes (30.2%) demonstrated nonneovascular SRF. The mean follow-up duration was 4.1 ± 4.0 years. In the overall cohort, both CMT and SFCT significantly decreased over time (P < 0.001 for both), whereas the prevalence of cRORA increased from 54.7% at baseline to 64.2% at final follow-up. Subretinal fluid prevalence decreased in both groups, from 100% to 40.5% in neovascular eyes and from 100% to 72.7% in nonneovascular eyes. Final VA was similar between neovascular and nonneovascular groups (0.40 ± 0.30 LogMAR [∼20/50 Snellen] vs. 0.32 ± 0.20 LogMAR [∼20/40 Snellen]; P = 0.62). Rates of cRORA at final follow-up were likewise comparable between groups (64.3% vs. 63.6%).
Conclusions:
Subretinal fluid associated with AS may result from exudative CNV or nonneovascular mechanisms likely related to RPE dysfunction. Despite distinct imaging phenotypes, long-term visual and structural outcomes were comparable between groups. These findings emphasize the importance of multimodal imaging confirmation of CNV to distinguish neovascular from nonneovascular fluid and avoid interpreting SRF alone as evidence of CNV activity.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
