Neovascular age-related macular degeneration without drusen.

Abstract

Purpose: To describe the clinical characteristics and 1-year follow-up of patients with neovascular AMD (nAMD) without drusen in either eye.

Methods: This is a multicentre retrospective cohort study in three tertiary referral centres in The Netherlands. We included patients of 55 years or older with nAMD in one or both eyes, without the presence of drusen or signs of another underlying disease in either eye. The medical charts and multimodal imaging (MMI) were evaluated by two independent graders. Eyes were divided into two groups: polypoidal choroidal vasculopathy (PCV)-associated macular neovascularization (MNV) and non-PCV MNV. We evaluated the visual acuity (VA) at baseline and 1 year after baseline; complete resolution of macular fluid on optical coherence tomography (OCT) during 1 year of follow-up; required treatments to achieve a complete resolution of macular fluid on OCT; complication rate.

Results: We included 106 eyes of 99 patients, with a median age of 73 years. Seventy-one eyes had PCV-associated MNV, and 35 eyes had non-PCV MNV. The overall median baseline VA was 0.22 logMAR (Snellen 20/30), and 0.15 logMAR (Snellen 20/28) at 1 year follow-up. Subretinal haemorrhage was more common in PCV-associated MNV compared to non-PCV MNV, both at initial presentation (21% vs. 17%) and during the 1 year follow-up period (23% vs. 11%). In total, 31 out of 48 eyes (65%) achieved complete resolution of macular fluid on OCT during follow-up, most commonly achieved with combined photodynamic therapy (PDT) + intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.

Conclusion: nAMD can occur without the presence of drusen in either eye. Treatment with anti-VEGF injections, PDT or a combination thereof appears to be effective, but more research is warranted.