Journal List > J Korean Ophthalmol Soc > v.57(7) > 1010338

Ahn, Ahn, Yang, and Yoon: Comparison of Optical Coherence Tomography Characteristics among Three Subtypes of Exudative Age-related Macular Degeneration

Abstract

Purpose

To compare the characteristics of optical coherence tomography in eyes with treatment-naïve typical neovascular age-related macular degeneration (typical nAMD), polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP).

Methods

One hundred fifty-three eyes newly diagnosed with exudative AMD were retrospectively collected. All study eyes were classified into three subtypes: typical nAMD, PCV, and RAP. Subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). Central macular thickness (CMT) and other OCT features including intraretinal cystoid fluid and subretinal fluid were also evaluated in all eyes. SFCT, CMT and other OCT features were compared among the three subtypes of exudative AMD.

Results

Seventy-four eyes with typical nAMD, 55 eyes with PCV, and 24 eyes with RAP were included. SFCT was significantly thickest in PCV and thinnest in RAP (p < 0.001). RAP showed the thickest CMT and the highest frequency of intraretinal cystoid fluid (p = 0.004, p < 0.001, respectively).

Conclusions

In patients with exudative AMD, different characteristics of OCT were observed according to the three subtypes. Identification of OCT characteristics could help differentiate the subtypes of exudative AMD.

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Figure 1.
Representative images of three subtypes of exudative age-related macular degeneration (AMD). Fundus photograph, indocyanine green angiography and optical coherence tomography images of typical neovascular AMD (A), polypoidal choroidal vasculopathy (B), and retinal angiomatous proliferation (C).
jkos-57-1093f1.tif
Figure 2.
Measurement of subfoveal choroidal thickness. The image was obtained using enhanced-depth imaging optical coherence tomography (OCT). Choroidal thickness (double-head arrow) was defined as the vertical distance drawn from the outer border of the retinal pigment epithelium to the inner border of the sclera using Cirrus High-Definition-OCT software.
jkos-57-1093f2.tif
Figure 3.
Central macular thickness modification using a built-in segmentation-modifying tool of optical coherence tomography. Segmentation lines for retinal pigment epithelium (red dotted line) are determined automatically for each of the volume scans, and the central macular thickness is provided (A). Using the modifying tool, the cursor line on retinal pigment epithelium is moved to the level of Bruch's membrane. With this movement, the modified central macular thickness is determined (B).
jkos-57-1093f3.tif
Figure 4.
Morphologic features of optical coherence tomography related to age-related macular degeneration. Intraretinal cystoid fluid is defined as round, hyporeflective cystic spaces within the neurosensory retina (A, arrow). Subretinal fluid is identified as non-reflective space between the posterior boundary of the neurosensory retina and the retinal pigment epithelium (B, arrow). Subretinal hyperreflective material appears as poorly defined, medium- to hyperreflective mass between neurosensory retina and retinal pigment epithelium (C, arrow). Pigment epithelial detachment is defined as a focal elevation of the reflective RPE band over an opti-cally clear or moderately reflective space (B, C; arrowhead).
jkos-57-1093f4.tif
Figure 5.
Comparative incidence of morphological features on optical coherence tomography in each subtypes of exudative age-related macular degeneration. Accounting for a Bonferroni correction, p-values less than 0.017 were considered to indicate statistical significance. nAMD = neovascular agerelated macular degeneration; PCV = polypoidal choroidal vasculopathy; RAP = retinal angiomatous proliferation; IRCF = intraretinal cytroid fluid; SRF = subretinal fluid; HRM = subretinal hyperreflective material; PED = pigment epithelial detachment. * The frequency of morphological characteristics which have p-values less than 0.017 when compared with other subtype using Chi-square test.
jkos-57-1093f5.tif
Table 1.
Demographic data of the patients
Characteristics Data
Number of eyes (n) 153
Age (years) 71.9 ± 8.6
Sex (M:F) 96:57
Mean BCVA (log MAR) 0.662 ± 0.458
Mean SFCT (μ m) 218.71 ± 64.47
Mean central macular thickness (μ m) 465.09 ± 161.17
OCT characteristics (eyes, n [%])  
  Intraretinal cytroid fluid 64 (41.8)
   Subretinal fluid 120 (78.4)
   Subretinal hyperreflective material 62 (40.5)
   Pigment epithelial detachment 142 (92.8)

Values are presented as mean ± SD or n (%)

BCVA = best corrected visual acuity; log MAR=logarithm of the minimum angle of resolution; SFCT = subfoveal choroidal thickness; OCT = optical coherence tomography.

Table 2.
Comparison of baseline characteristics among three subtypes of exudative age-related macular degeneration
  Typical nAMD PCV RAP p-value
Number of eyes (n, %) 74 (48.4%) 55 (35.9%) 24 (15.7%)  
Age (years) 72.9 ± 8.5 69.8 ± 8.8 73.4 ± 7.9 0.086
Sex (M:F) 48:26 37:18 11:13 0.169
Mean SE (diopters) 0.18 ± 1.03 0.31 ± 0.82 0.40 ± 1.34 0.824
Mean BCVA (log MAR) 0.665 ± 0.490 0.657 ± 0.471 0.666 ± 0.323 0.993
Mean SFCT (μ m) 207.26 ± 57.16 253.76 ± 65.38 173.71 ± 39.83 <0.001*
Mean CMT (μ m) 442.39 ± 168.96 452.27 ± 135.87 564.46 ± 159.27 0.004*

Values are presented as mean ± SD unless otherwise indicated. One way ANOVA for continuous variables; χ2 test for categorical variables. nAMD = neovascular age-related macular degeneration; PCV = polypoidal choroidal vasculopathy; RAP = retinal angiomatous proliferation; SE = spherical equivalent; BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; SFCT = subfoveal choroidal thickness; CMT = central macular thickness.

* p-value<0.05 was set as statistical significance.

Table 3.
Post-hoc analysis p-value among three subtypes
  Typical nAMD vs. PCV p-value e PCV vs. RAP p-value R RAP vs. typical nAMD p-value
Subfoveal choroidal thickness <0.001* <0.001* 0.010*
Central macular thickness 1.000 0.012* 0.003*

Bonferroni's method for post-hoc analysis.

nAMD = neovascular age-related macular degeneration; PCV = polypoidal choroidal vasculopathy; RAP = retinal angiomatous proliferation.

* p-value<0.05 was set as statistical significance.

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