Widespread choroidal thickening and abnormal midperipheral fundus autofluorescence characterize exudative age-related macular degeneration with choroidal vascular hyperpermeability

Abstract

Yoko Nomura, Hidenori Takahashi, Xue Tan, Ryo Obata, Yasuo Yanagi Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, the University of Tokyo, Tokyo, Japan Purpose: To investigate the clinical findings that characterize exudative age-related macular degeneration (AMD) with choroidal vascular hyperpermeability (CVH).Design: Retrospective comparative study.Participants: Forty-eight consecutive patients attending the outpatient clinic of Tokyo University Hospital between May 2013 and July 2013.Methods: The presence or absence of CVH was determined with indocyanine green angiography performed at the latest visit. When CVH was observed, the eye was categorized as CVH(+) AMD, otherwise it was categorized as CVH(-) AMD. Using high-penetration optical coherence tomography, we measured choroidal thickness at the fovea and at four midperipheral areas (mean choroidal thickness at points on 6- and 9-papilla diameter circles superior, inferior, temporal, and nasal to the fovea). Ultrawide field retinal imaging was used to investigate abnormalities in midperipheral fundus autofluorescence (FAF). Choroidal thickness and the proportion of FAF abnormalities were compared between the CVH(+) AMD and CVH(-) AMD eyes and between eyes with polypoidal choroidal vasculopathy and typical AMD. Multiple regression analysis was used to control for treatment history and other characteristics.Results: CVH was observed in 17 cases. Choroidal thickness was higher in the CVH(+) AMD eyes than in the CVH(-) AMD eyes at the fovea (325 µm versus 229 µm, respectively; P=0.0010, t-test), superior point (277 µm versus 215 µm, respectively; P=0.0021, t-test), inferior point (225 µm versus 161 µm, respectively; P=0.0002, t-test), and nasal point (202 µm versus 165 µm, respectively; P=0.042, t-test). The significance was maintained after controlling for possible confounders. The choroid was thicker at the fovea and at the inferior point in polypoidal choroidal vasculopathy than in typical AMD. The rate of midperipheral FAF abnormality was significantly higher in the CVH(+) AMD eyes than in the CVH(-) AMD eyes (82% versus 48%, respectively; P=0.031).Conclusion: AMD with CVH is associated with widespread choroidal thickening and peripheral FAF abnormalities. Keywords: age-related macular degeneration, hyperpermeability, choroidal thickness, autofluorescence, high-penetration optical coherence tomography