The second eye of Japanese patients with unilateral exudative age related macular degeneration

Abstract

Aim: To clarify the incidence of choroidal neovascularisation (CNV) and predisposing findings for development of CNV in the second eye of Japanese patients with unilateral exudative age related macular degeneration (AMD).

Methods: The second eyes of unilaterally affected patients with exudative (neovascular) AMD treated in our clinic during the past 10 years (1988-97) were carefully followed up for more than a year. Evidence of CNV was confirmed by fluorescein and indocyanine green angiography. Macular lesions in patients, in whom CNV developed in the second eye, were retrospectively evaluated from patient records.

Results: 170 patients met the criteria. The average follow up period was 47 months (range 12-108 months). All patients were Japanese. CNV developed in the second eye in 12 (7%) of 170 patients, 30.3 months on average after the first examination. Cumulative incidence of developing CNV in the second eye using Kaplan-Meier life table analysis was: 0.6% by 1 year, 5.6% by 3 years, and 12.3% by 5 years, and was relatively low compared with that in white patients. CNV developed most frequently from serous pigment epithelial detachment (PED) in the macula (58%). Soft drusen were not prevalent and risk of developing CNV was not very high (18%).

Conclusion: It was confirmed that there were some differences in the incidence and predisposing findings for CNV developing in AMD among Japanese and other Asian patients compared with those in white people. It is important to recognise these differences between the two populations to understand the pathogenesis and epidemiology of AMD.

Figure 1

Fundus photograph of serous retinal detachment associated with a small nodular yellowish-white lesion (fibrovascular membrane), tiny haemorrhage, and lipid deposits. A typical macular manifestation in the early stage of exudative age related macular degeneration.

Figure 2

Fundus photograph of subretinal and subpigment epithelial haemorrhage (haemorrhagic pigment epithelial detachment, PED). A typical manifestation of exudative AMD.

Figure 3

Fundus photograph of subretinal fibrinous exudation and fibrovascular membrane with serous retinal detachment, subretinal haemorrhage, and lipid deposits. This lesion is a so called disciform lesion, and one of the typical manifestations of exudative AMD.

Figure 4

Fundus photograph of subretinal fibrous scar. This lesion is the end stage of exudative AMD.

Figure 5

Exudative AMD derived from predisposing a serous PED. (A) Fundus photograph of a large serous PED accompanied by a small fibrovascular membrane (arrow) and lipid deposits. (B) Fundus photograph of haemorrhagic PED. A large serous PED contained bleeding at the bottom of the PED. (C) Fundus photograph of a large serous PED associated with serous retinal detachment and lipid deposits. (D) Fundus photograph of serous PED (large arrow) associated with subretinal exudation, serous retinal detachment, and subretinal fibrovascular membrane (small arrow).

Figure 6

Fundus photograph of degeneration of the retinal pigment epithelium (RPE) at the macula. This is one of the predisposing findings for developing choroidal neovascularisation (CNV).

Figure 7

Fundus photograph of hard drusen, seen in elderly patients.

Figure 8

Fundus photograph of soft drusen.

Figure 9

Fundus photograph of large confluent soft drusen. This is a typical predisposing finding of developing CNV. In the elderly, particularly in white people with AMD, they are very prevalent, but in Japanese they are not so prevalent.

Figure 10

Fundus photograph of a serous PED. This lesion is the commonest predisposing finding for developing CNV in Japanese. CNV develops inside or beside serous PED.

Figure 11

Kaplan-Meier survival curve for development of CNV in the second eye in unilateral exudative AMD (170 eyes).