Neovascular age-related macular degeneration without drusen in the fellow eye: clinical spectrum and therapeutic outcome

Figures & data

Figure 1 Spectrum of neovascular age-related macular degeneration without drusen in the fellow eye.

Notes: (A–D) Multimodal imaging of a 72-year-old female patient with neovascular age-related macular degeneration. Fundus photography (A) showed a central macular neovascular lesion with hemorrhage. On FA (B), a type 2 neovascularization was present. On OCT (C), accumulation of hyperreflective subretinal debris and subretinal fluid was visible. On OCT of the fellow eye (D) at initial diagnosis, no drusen were present. (E–I) Multimodal imaging of a 64-year-old female patient with polypoidal choroidal vasculopathy. On fundus autofluorescence (E), serous maculopathy and a PED in the macular region were visible. FA (F) showed a type 2 neovascularization. The indocyanine green angiograph (G) revealed a polyp below the PED. On OCT (H), hyperreflective material below the retinal pigment epithelium was seen. On OCT of the fellow eye (I) no drusen were present.
Abbreviations: FA, fluorescein angiography; OCT, optical coherence topography; PED, pigment epithelial detachment.

Table 1 Baseline characteristics of patients with neovascular age-related macular degeneration without drusen in the fellow eye

Baseline characteristics
N	29
Gender, (n [%])
Male	16 (55)
Female	13 (45)
Age at onset (mean ± SD)	75±10 years
Diagnosis
nAMD (n)	26
PCV (n)	3
Number of patients with drusen in the eye with nAMD	1/29
Type of CNV
Type 1 (n)	18
Type 2 (n)	7
Mixed, minimally classic (n)	2
Mixed, predominantly classic (n)	2
ETDRS BCVA letter score (mean ± SD)	57±24
Snellen equivalent (mean ± SD)	20/67±20/333
Central retinal thickness (µm) (mean ± SD)	408±154
Number of patients who completed follow-up
6 months	25/29
12 months	23/29
24 months	17/29
Number of days until follow-up visit (mean, range)
First follow-up	86 (14–154)
6 months	192 (153–280)
12 months	356 (302–431)
24 months	703 (520–995)

Abbreviations: BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; ETDRS, Early Treatment Diabetic Retinopathy Study; nAMD, neovascular age-related macular degeneration; PCV, polypoidal choroidal vasculopathy; SD, standard deviation.

Table 2 Treatment and number of received intravitreal injections during follow-up

Treatment after baseline visit until first follow-up visit
Bevacizumab (number of patients/mean number of injections)	21/2.95
Ranibizumab (number of patients/mean number of injections)	2/2
PDT* + bevacizumab (number of patients/mean number of injections)	4/3.50
Treatment from first follow-up visit until 6 months after initial diagnosis
Bevacizumab (number of patients/mean number of injections)	15/2.53
Ranibizumab (number of patients/mean number of injections)	3/3.33
PDT** + aflibercept (number of patients/mean number of injections)	1/2
Treatment from 6 months until 12 months after initial diagnosis
Bevacizumab (number of patients/mean number of injections)	11/3.09
Ranibizumab (number of patients/mean number of injections)	4/4.75
Aflibercept (number of patients/mean number of injections)	4/3.50
PDT*** + aflibercept (number of patients/mean number of injections)	1/3
Treatment from 12 months until 24 months after initial diagnosis
Bevacizumab (number of patients/mean number of injections)	10/4.60
Ranibizumab (number of patients/mean number of injections)	2/4.50
Aflibercept (number of patients/mean number of injections)	4/3.50

Notes:

* During this time frame 3 patients received 1 session full-dose PDT and 1 patient received 1 session of half-dose PDT.

** 1 session of half-dose PDT.

*** 1 session of full-dose PDT.

Abbreviation: PDT, photodynamic therapy.

Figure 2 Mean change in BCVA during follow-up, compared to baseline.

Note: *Indicates statistical significance.
Abbreviations: BCVA, best-corrected visual acuity; ETDRS, Early Treatment Diabetic Retinopathy Study; SE, standard error.

Table 3 Treatment and best-corrected visual acuity of patients with polypoidal choroidal vasculopathy during follow-up

PCV patient number	ETDRS BCVA letter score at baseline	Received treatments after baseline visit until first follow-up visit	ETDRS BCVA letter score at first follow-up	Received treatments between first follow-up and 6 months after baseline	ETDRS BCVA letter score at 6 months after baseline	Received treatments between 6 and 12 months after baseline	ETDRS BCVA letter score at 12 months after baseline	Received treatments between 12 and 24 months after baseline
1	78	Full-dose PDT, 2× bevacizumab	76	None	N/A	N/A	N/A	N/A
2	73	Full-dose PDT, 3× bevacizumab	82	3× bevacizumab	76	None	76	None
3	76	3× bevacizumab	69	Half-dose PDT, 2× aflibercept	74	2× aflibercept	71	1× aflibercept

Abbreviations: BCVA, best-corrected visual acuity; ETDRS, Early Treatment Diabetic Retinopathy Study; N/A, information not available; PCV, polypoidal choroidal vasculopathy; PDT, photodynamic therapy.

Figure 3 Mean change in CRT during follow-up, compared to baseline.

Note: *Indicates statistical significance.
Abbreviations: CRT, central retinal thickness; SE, standard error.

Figure 4 Mean CRT during follow-up per type of neovascularization (type 1 versus type 2).

Notes: Δ indicates the difference in decrease of CRT between the 2 subgroups (decrease in µm within the patient group with type 1 neovascularization minus the decrease in µm within the patient group with type 2 neovascularization).
Abbreviations: CRT, central retinal thickness; SE, standard error.

Table 4 Received treatments in several patients in whom subretinal fluid resolved for ≥3 months after treatment

Patient	Diagnosis	Treatment
1	nAMD	3× bevacizumab
2	nAMD	6× bevacizumab
3	nAMD	3× bevacizumab
4	nAMD	8× bevacizumab, 3× ranibizumab, 1 session of full-dose PDT
5	nAMD	6× bevacizumab
6	PCV	2× bevacizumab, 1 session of full-dose PDT

Abbreviations: nAMD, neovascular age-related macular degeneration; PCV, polypoidal choroidal vasculopathy; PDT, photodynamic therapy.