J Korean Ophthalmol Soc.  2016 Jul;57(7):1093-1101. 10.3341/jkos.2016.57.7.1093.

Comparison of Optical Coherence Tomography Characteristics among Three Subtypes of Exudative Age-related Macular Degeneration

• Ahn SE
• Ahn DS
• Yang H
• Yoon HS

• KMID: 2317570
• DOI: http://doi.org/10.3341/jkos.2016.57.7.1093

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.

Keyword

Age-related macular degeneration; Optical coherence tomography; Polypoidal choroidal vasculopathy; Retinal angiomatous proliferation

MeSH Terms

Choroid
Humans
Macular Degeneration*
Retinaldehyde
Retrospective Studies
Subretinal Fluid
Tomography, Optical Coherence*
Retinaldehyde

Figure

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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).

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  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.

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  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).

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  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).

• 

  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.

Reference

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