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Exudative non-neovascular age-related macular degeneration

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To describe the clinical and multimodal imaging (MMI) features of age-related macular degeneration (AMD) eyes presenting with intraretinal exudation and no evidence of neovascularization or structural alterations of native retinal vessels.

Methods

This was a retrospective review of the MMI and electronic health records for 3 consecutive patients presenting with unilateral exudative non-neovascular age-related macular degeneration. MMI included confocal color fundus photography (CFP), fundus autofluorescence (FAF), fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), swept-source optical coherence tomography angiography (SS-OCTA), and spectral domain optical coherence tomography angiography (SD-OCTA). Dense B-scan OCTA (DB-OCTA) patterns and implemented image post-processing were used to improve spatial resolution in the OCTA analysis and remove projection artifacts.

Results

Three eyes of 3 patients (1 male and 2 females, ages 72–87) developed intraretinal fluid (IRF) producing retinal edema during regular follow-up for non-neovascular AMD. FA, SS-OCTA, and DB-OCTA demonstrated no evidence of macular neovascularization or discrete retinal vascular abnormalities that could explain the IRF accumulation. Two eyes received intravitreal anti-VEGF therapy and demonstrated prompt resolution of IRF with periodic recurrences over time.

Conclusion

Exudative non-neovascular AMD is a novel clinical phenotype characterized by the presence of non-neovascular intraretinal exudation producing macular edema. Differentiating this condition from other manifestations of AMD requires appropriate use of MMI. Further study is needed to assess the clinical impact and optimal management of exudative non-neovascular AMD.

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Data availability

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Funding

This work was supported by The Macula Foundation Inc., New York, NY.

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Authors and Affiliations

  1. Vitreous Retina Macula Consultants of New York, 950 Third Ave., New York, NY, 10022, USA

    Tommaso Bacci, Juliet O. Essilfie, Belinda C. S. Leong & K. Bailey Freund

  2. Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy

    Tommaso Bacci

  3. Department of Ophthalmology, New York University, New York, NY, USA

    Juliet O. Essilfie & K. Bailey Freund

  4. Manhattan Eye, Ear, and Throat Hospital, Lenox Hill Hospital, New York, NY, USA

    Juliet O. Essilfie & K. Bailey Freund

  5. Retina Associates, Sydney, Australia

    Belinda C. S. Leong

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  1. Tommaso Bacci
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Corresponding author

Correspondence to K. Bailey Freund.

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Conflict of interest

K.B. Freund is a consultant for Heidelberg Engineering, Zeiss, Allergan, Regeneron, Bayer, and Novartis. He receives research support from Genentech/Roche. T. Bacci, J.O. Essilfie, and B.C.S. Leong have no disclosures.

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All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Bacci, T., Essilfie, J.O., Leong, B.C.S. et al. Exudative non-neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 259, 1123–1134 (2021). https://doi.org/10.1007/s00417-020-05021-y

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  • DOI: https://doi.org/10.1007/s00417-020-05021-y

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