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. 2011 Apr;25(4):481-8.
doi: 10.1038/eye.2010.232. Epub 2011 Jan 21.

Development of polypoidal lesions in age-related macular degeneration

A Tsujikawa  1 , Y Ojima, K Yamashiro, S Ooto, H Tamura, I Nakata, N Yoshimura
Affiliations

Development of polypoidal lesions in age-related macular degeneration

A Tsujikawa et al. Eye (Lond). 2011 Apr.

Abstract

Purpose: To investigate the development of polypoidal lesions using indocyanine green angiography (IA) in eyes with typical age-related macular degeneration (AMD).

Methods: We retrospectively reviewed the medical records of 47 consecutive patients (47 eyes) with typical AMD who had been followed up with IA for at least 2 years.

Results: At the initial visit, although all eyes showed classic and/or occult choroidal neovascularization (CNV) associated with AMD, no eyes showed polypoidal lesions by IA. However, during follow-up, 13 (27.7%) of the 47 eyes did show polypoidal lesions. All polypoidal lesions developed at the edge of persistent CNV or, more often, at the terminus of recently progressed CNV. Of 12 eyes with a final lesion area >8 disc area, 7 (58.3%) showed newly developed polypoidal lesions. In the eyes with these newly developed polypoidal lesions, the mean area of the vascular lesion had extended significantly from 10.50 ± 7.88 mm² to 20.87 ± 10.21 mm² during follow-up (P=0.0018).

Conclusion: The current observation suggests that IA of active AMD sometimes reveals polypoidal lesions if there is progression of the CNV in the subretinal pigment epithelium space.

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Figures

Figure 1
Figure 1
(a) Correlation between initial and final areas of the lesion in eyes with typical age-related macular degeneration. Initial areas are significantly correlated with final areas of the lesion (R=0.7347, P<0.0001). (b) Correlation between initial and final greatest linear dimension (GLD) in eyes with typical age-related macular degeneration. Initial GLD is significantly correlated with final GLD (R=0.7349, P<0.0001). One disc area (DA) is estimated to be 2.54 mm2 on the basis of one optic disc diameter being 1.8 mm. Open diamonds represent eyes without polypoidal lesions, and closed diamonds represent eyes with polypoidal lesions.
Figure 2
Figure 2
Development of polypoidal lesions at the border of persistent choroidal neovascularization (CNV) in a right eye with typical age-related macular degeneration. (a) Fundus photograph at the initial visit shows a multi-lobed serous pigment epithelial detachment (PED). Visual acuity was 0.8 in this eye. (b) Fluorescein angiography (FA) at the initial visit shows only hyperfluorescent areas associated with the PED. (c) Indocyanine green angiography (IA) shows CNV (arrow) at the edge of the PED; no polypoidal lesions are seen. (d) Fundus photograph at 34 months after the initial visit. With two photodynamic treatments, activity of the CNV has regressed. Visual acuity was now 0.2 in the right eye. (e) At 50 months after the initial visit, new serosanguineous PEDs (arrows) have developed at the upper side and at the inferotemporal side of the subfoveal disciform scar. (f) IA shows multiple polypoidal lesions (arrows) at the edge of the persistent CNV. Visual acuity was 0.1 in this eye.
Figure 3
Figure 3
Development of polypoidal lesions at the terminus of newly progressed choroidal neovascularization (CNV) in a left eye with typical age-related macular degeneration. (a) Fundus photograph at the initial visit; at which time visual acuity in this eye was 1.2. (b) Fluorescein angiography (FA) at the initial visit shows inactive occult CNV. (c) Indocyanine green angiography (IA) shows no polypoidal lesions. (d) At 34 months after the initial visit, visual acuity had decreased to 0.15. Fundus photograph shows an active exudative change at the temporal side of a subfoveal disciform scar. (e) FA shows large subfoveal classic CNV with temporal active leakage from the CNV (arrow). (f) IA shows mature subfoveal CNV (long arrow). The CNV has progressed temporally and now forms multiple terminal bulbs, which are seen as polypoidal lesions (arrow). Three intravitreal injections of bevacizumab caused activity of the CNV to regress. (g) At 64 months after the initial visit, a new active lesion has developed on the upper border of the subfoveal disciform scar. Visual acuity, however, remained at 0.15. (h) FA shows newly developed CNV (arrow). (i) IA shows what are presumed to be newly developed polypoidal lesions (arrow).
Figure 4
Figure 4
Development of polypoidal lesions at the terminus of recently progressive choroidal neovascularization (CNV) in a right eye with typical age-related macular degeneration. (a) Fundus photograph at the initial visit shows atrophy of the retinal pigment epithelium. Visual acuity was 0.4 in the right eye. (b) Fluorescein angiography (FA) at the initial visit shows subfoveal occult CNV. (c) Indocyanine green angiography (IA) shows CNV beneath the fovea, but no polypoidal lesions are seen. With photodynamic therapy, activity of the CNV regressed. (d) At 24 months after the initial visit, a new active lesion has developed at the temporal side of the regressed CNV. Visual acuity at this time was 0.4 in the right eye. (e) IA reveals multiple polypoidal lesions (arrows) at the edge of the progressive CNV. (f) Magnified IA shows that some of the polypoidal lesions consist of coiled vessels (arrow).
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