Abstract
Purpose
To comprehend the clinical characteristics and factors related to visual prognosis in two major subtypes of neovascular age-related macular degeneration (AMD)—traditional, typical AMD and polypoidal choroidal vasculopathy (PCV).
Methods
Medical records of 272 eyes of 216 patients diagnosed with neovascular AMD at Kyoto University Hospital between January 2000 and March 2003 were retrospectively reviewed for up to 3 years. Ophthalmoscopic, angiographic, and optical coherence tomography (OCT) findings were collected, and univariate and multivariate analyses were performed to determine the characteristic factors, the factors associated with initial visual acuity (VA), and visual prognosis in typical AMD and PCV.
Results
We studied 154 eyes with typical AMD and 117 eyes with PCV. The presence of classic choroidal neovascularization (CNV) and posterior confluent drusen were characteristic of typical AMD, whereas PCV was characterized by a larger number of retinal pigment epithelial detachments and a small number of drusen. Poor initial VA (<0.1) was significantly associated with subfoveal classic CNV, hard exudates, late fibrosis staining of >−1 disc area in AMD, and with blood and cystoid macular edema in PCV. Maintenance of good VA was associated with better initial VA in typical AMD and with smaller lesions in PCV.
Conclusion
Typical AMD and PCV revealed statistical differences both in their clinical characteristics and in the factors associated with visual prognosis.
Similar content being viewed by others
References
Fine SL, Berger JW, Maguire MG, Ho AC. Age-related macular degeneration. N Engl J Med 2000;342:483–492.
Klein R, Klein BE, Linton KL. Prevalence of age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology 1992;99:933–943.
Vingerling JR, Dielemans I, Hofman A, et al. The prevalence of age-related maculopathy in the Rotterdam Study. Ophthalmology 1995;102:205–210.
Mitchell P, Smith W, Attebo K, Wang JJ. Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology 1995;102:1450–1460.
Bird AC, Bressler NM, Bressler SB, et al. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol 1995;39:367–374.
Oshima Y, Ishibashi T, Murata T, et al. Prevalence of age related maculopathy in a representative Japanese population: the Hisayama study. Br J Ophthalmol 2001;85:1153–1157.
Macular Photocoagulation Study Group. Subfoveal neovascular lesions in age-related macular degeneration. Guidelines for evaluation and treatment in the macular photocoagulation study. Arch Ophthalmol 1991;109:1242–1257.
Hayashi K, Hasegawa Y, Tazawa Y, de Laey JJ. Clinical application of indocyanine green angiography to choroidal neovascularization. Jpn J Ophthalmol 1989;33:57–65.
Guyer DR, Yannuzzi LA, Slakter JS, et al. Classification of choroidal neovascularization by digital indocyanine green videoangiography. Ophthalmology 1996;103:2054–2060.
Yannuzzi LA, Sorenson J, Spaide RF, Lipson B. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina 1990;10:1–8.
Yannuzzi LA, Ciardella A, Spaide RF, et al. The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 1997;115:478–485.
Yannuzzi LA, Negrao S, Iida T, et al. Retinal angiomatous proliferation in age-related macular degeneration. Retina 2001;21:416–434.
Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science 1991;254:1178–1181.
MacCumber MW, Dastgheib K, Bressler NM, et al. Clinicopathologic correlation of the multiple recurrent serosanguineous retinal pigment epithelial detachments syndrome. Retina 1994;14:143–152.
Lafaut BA, Aisenbrey S, van den Broecke C, et al. Polypoidal choroidal vasculopathy pattern in age-related macular degeneration. A clinicopathologic correlation. Retina 2000;20:650–654.
Okubo A, Sameshima M, Uemura A, et al. Clinicopathological correlation of polypoidal choroidal vasculopathy revealed by ultrastructural study. Br J Ophthalmol 2002;86:1093–1098.
Sho K, Takahashi K, Yamada H, et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol 2003;121:1392–1396.
Maruko I, Iida T, Saito M, et al. Clinical characteristics of exudative age-related macular degeneration in Japanese patients. Am J Ophthalmol 2007;144:15–22.
Gass JD, Agarwal A, Lavina AM, Tawansy KA. Focal inner retinal hemorrhages in patients with drusen: an early sign of occult choroidal neovascularization and chorioretinal anastomosis. Retina 2003;23:741–751.
Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials—TAP report 1. Arch Ophthalmol 1999;117:1329–1345.
Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: two-year results of 2 randomized clinical trials—TAP report 2. Arch Ophthalmol 2001;119:198–207.
Gass JD. Biomicroscopic and histopathologic considerations regarding the feasibility of surgical excision of subfoveal neovascular membranes. Am J Ophthalmol 1994;118:285–298.
Yannuzzi LA, Wong DW, Sforzolini BS, et al. Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration. Arch Ophthalmol 1999;117:1503–1510.
Wen F, Chen C, Wu D, Li H. Polypoidal choroidal vasculopathy in elderly Chinese patients. Graefes Arch Clin Exp Ophthalmol 2004;242:625–629.
Kwok AK, Lai TY, Chan CW, et al. Polypoidal choroidal vasculopathy in Chinese patients. Br J Ophthalmol 2002;86:892–897.
Ahuja RM, Stanga PE, Vingerling JR, et al. Polypoidal choroidal vasculopathy in exudative and haemorrhagic pigment epithelial detachments. Br J Ophthalmol 2000;84:479–484.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Hirami, Y., Mandai, M., Takahashi, M. et al. Association of clinical characteristics with disease subtypes, initial visual acuity, and visual prognosis in neovascular age-related macular degeneration. Jpn J Ophthalmol 53, 396–407 (2009). https://doi.org/10.1007/s10384-009-0669-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10384-009-0669-4