The Effects Of The Morphological Changes Of Retinal Pigment Epithelium On The Outcome Of Choroidal Neovascularization

ObjectivesTo analyze the effects of the morphological changes of retinal pigment epithelium (RPE) on the outcome of choroidal neovascularization (CNV), with highlight on exudative age-related macular degeneration (AMD), by means of evaluating the characteristics of CNV on optical coherence tomography (OCX), fluorecein angiography and indocyanine green angiography. Material and methods1. The general profile of 233 consecutive patients with CNV examined at the Ophthalmic Department of the PLA General Hospital between October 2000 and December 2003 was described. The advantages of OCT in disclosing the morphological changes of RPE associated with CNV were evaluated.2. One hundred and seventy-one eyes of 140 exudative AMD patients underwent OCT examination were selected, with 113 eyes presented with pigment epithelium detachment (PED). Osiris medical imaging software (version 4.18) was used to measure the angle, height and base diameter of PED. The relationship between the morphology of PED and the evolution of RPE tear was evaluated.3. Patients underwent OCT examination were all selected, including 171 eyes of 140 patients with exudative AMD and 74 eyes of 62 patients with CNV secondary to non-AMD. The correlation between the types of CNV, the morphological changes of RPE and the development of cystoid macular edema (CME) was analyzed.4. Patients underwent both OCT and fluorecein angiography (FA) examinations were selected, including 83 eyes of 73 patients with exudative AMD and 47 eyes of 40 patients with CNV secondary to non-AMD. The correlation between Retinal-Choroidal Anastomosis (RCA) and FED was evaluated. Forty-three eyes of 40 patients with active AMD lesions underwent OCT and simultaneous fluorescein and indocyanine green angiography (FA/ICGA) examinations were further investigated for the sources of subretinal neovascularization. Results1. The majority of patients with CNV were secondary to exudative AMD (69.10%); the minority was associated with CEC (17.60%), pathologic myopia (8.15%), choroiditis (3.86%), choroidal rupture (0.86%) and angiod streaks (0.43%) in descending order. Men with exudative AMD were more than two times as much as women, and the mean age of men was significantly older than women (P=0.0013). FED was much more common in exudative AMD than in non-AMD (77.93% versus 39.62%). The height and base diameter of FED associated with AMD (0.30 ± 0.20mm and 2.02±1.23mm) were significantly greater than that of non-AMD(0.21 ± 0.1 mm and 0.99 ± 0.34mm).2. FED tear associated with exudative AMD occurred more often at the edge (69.12%). Compared with FED without tear, FED with tear had significantly larger angle and higher height. FED with marginal tear showed even larger angle and higher height as compared with FED with non-marginal tear.3. The incidence of CME was significantly higher in exudative AMD than innon-AMD (52.05% versus 24.32%). In the active phase of exudative AMD, most of eyes with CME had either a combined CNV complex (76.32%) or a Gass 2 type CNV (18.42%), whereas, most of eyes without CME had Gass 1 type CNV (82.61%). The difference was statistically significant CP=0.0000).4. Forty-five point thirty-three percent of eyes with exudative AMD were found to have RCA; most of the anastomotic connection involved the retinal vein. Compared with eyes without RCA, FED tear was a more common sign in eyes with RCA (88.67% versus 51.52%, P=0.0030). The incidence of RCA formation was significantly higher in AMD than in non-AMD (45.33% versus 15%, P=0.0010). Eyes with RCA had their main portion of neovascular complex originated from choroid. Conclusions1. The higher proportion of old army men in this series was the reason for men with exudative AMD outnumbered women. It might be associated with imbalance of sex hormone after menopause for most women suffered from exudative AMD earlier than men. OCT is superior in visualizing the early structural changes of RPE associated with CNV.2. The occurrence of marginal FED tear associate...