Exudative non-neovascular age-related macular degeneration
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RETINAL DISORDERS
Exudative non-neovascular age-related macular degeneration Tommaso Bacci 1,2
&
Juliet O. Essilfie 1,3,4 & Belinda C. S. Leong 1,5 & K. Bailey Freund 1,3,4
Received: 4 October 2020 / Revised: 12 November 2020 / Accepted: 16 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 (SDOCT), 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 nonneovascular AMD.
Key messages We describe the clinical and multimodal imaging features of age-related macular degeneration (AMD) eyes presenting with intraretinal exudation and no evidence of neovascularization or structural alterations of native retinal vessels. This AMD variant should be distinguished from other pathologic conditions with similar optical coherence tomography findings, such as retinal pseudocysts, early type 3 macular neovascularization (MNV), perifoveal exudative vascular anomalous complex (PEVAC) and type 1 MNV associated with retinal pigment and outer retinal atrophy. Intraretinal fluid accumulation in eyes with AMD should not always be interpreted as the result of purely degenerative or neovascular processes.
* K. Bailey Freund [email protected] 1
Vitreous Retina Macula Consultants of New York, 950 Third Ave., New York, NY 10022, USA
2
Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena
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