Treatment-naïve quiescent macular neovascularization secondary to AMD: The 2019 Young Investigator Lecture of Macula Society
Giuseppe Querques, Riccardo Sacconi, Vittorio Capuano, Adriano Carnevali, Donato Colantuono, Marco Battista, Enrico Borrelli, Alexandra Mière, Mariacristina Parravano, Eliana Costanzo, Lea Querques, Eric H. Souied, Francesco Bandello
Abstract
Purpose: To analyze different clinical and anatomical features in treatment-naïve non-exudative macular neovascularizations (MNVs) secondary to age-related macular disease (AMD). Methods: In this retrospective longitudinal study with a minimum follow-up of 1 year, 31 eyes of 28 consecutive AMD patients (mean age 75 ± 9 years) with treatment-naïve non-exudative MNV were enrolled. Patients were divided in: short-term activated MNV group (exudation before 6-month) and quiescent MNV group (per definition no exudation during a minimum 6-month follow-up) showing no or late activation during follow-up (persistently quiescent and long-term activated MNV group, respectively). Results: During the follow-up (mean duration: 22 ± 9 months) four eyes (13%) showed exudation before 6-month follow-up (short-term activated MNV group), whereas 21 eyes (68%) did not develop signs of exudation (persistently quiescent group), and six eyes (19%) developed exudation after the minimum 6-month follow-up (long-term activated MNV group). Monthly MNV growth rate was significantly higher in the short-term activated MNV group (growth rate of 13.30%/month), vs persistently quiescent MNV group (0.64%/month, p < 0.001) and long-term activated quiescent MNV group (1.07%/month, p < 0.001). Furthermore, at the baseline, perfusion density of short-term activated MNV group was significantly greater in comparison to persistently quiescent MNV group ( p = 0.001) and long-term activated MNV group ( p = 0.106). Conclusion: We reported two different patterns for subclinical MNVs: subclinical MNVs characterized by short-term activation which could represent simply a pre-exudative stage in the development of an ordinary type 1 MNV, and quiescent MNVs characterized by low rate of growth and possible long-term activation. Analysis of OCT-A features may predict short-term activation for subclinical MNV but no features could predict the long-term activation.