Purpose To investigate the anatomical changes and the macular function in neovascular age-related macular degeneration (AMD) eyes, according to the recognition of either fibrocellular or fibrovascular phenotype.
Methods We enrolled eyes with previously treated neovascular AMD in remission (no subretinal haemorrhage, sign of fluid in or under the retina and no treatment for at least 6 months). Subjects underwent multimodal imaging assessment and were tested for macular sensitivity using microperimetry. The study cohort was divided according to the presence of fibrosis on multicolour (MC) images, yielding two distinct phenotypic subgroups: (1) fibrocellular group and (2) fibrovascular group.
Results Nineteen eyes were classified as fibrocellular on MC images, while 22 eyes as fibrovascular. Mean±SD age was 73.9±11.0 years in the fibrocellular group and 75.9±7.1 years in the fibrovascular group (p=0.221). Best-corrected visual acuity was 0.7±0.5 logarithm of the minimum angle of resolution (LogMAR) in the fibrocellular group and 0.3±0.2 LogMAR in the fibrovascular group (p=0.003). On the optical coherence tomography and fundus autofluorescence evaluation, 17/19 eyes with the fibrocellular phenotype and 8/22 eyes with the fibrovascular phenotype displayed the presence of retinal pigment epithelium (RPE) atrophy (p=0.001). The perfusion density within the neovascular lesion was 28.9%±9.9% in the fibrocellular group and 44.2%±5.9 % in the fibrovascular group (p<0.0001).
Conclusion Neovascular AMD eyes in remission and with evidence of fibrocellular scar are characterised by RPE atrophy and reduced perfusion, which are associated with a higher degree of functional impairment. These findings suggest that maturation of vessels in fibrosis might be a better target in neovascular AMD treatments rather than their abolishment.
- age-related macular degeneration
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Contributors LQ, MP, FB, and GQ contributed to the study concept and design. LQ and MP contributed to the drafting of the manuscript. LQ was responsible for the statistical analysis. FB and GQ supervised the study. All authors contributed to the acquisition, analysis or interpretation of data and critical revision of the manuscript for important intellectual content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests GQ has the following disclosures: Allergan (S), Alimera (S), Amgen (S), Bayer (S), KHB (S), Novartis (S), Roche (S), Sandoz (S), Zeiss (S); Allergan (C), Alimera (C), Bausch and Lomb (C), Bayer (C), Heidelberg (C), Novartis (C), Zeiss (C). FB has the following disclosures: Allergan (S), Alimera (S), Bayer (S), Farmila-Thea (S), Schering Pharma (S), Sanofi Aventis (S), Novagali (S), Pharma (S), Hoffmann-La Roche (S), Genetech (S), Novartis (S). MP has the following disclosures: Allergan (S), Bayer (S) and Novartis (S).
Patient consent for publication Obtained.
Ethics approval Institutional Review Board (IRB) approval was obtained from University Vita-Salute San Raffaele (Milan, Italy) and G. B. Bietti Eye Foundation-IRCCS (Rome, Italy).
Provenance and peer review Not commissioned; externally peer reviewed.