Multimodal imaging of early stage 1 type 3 neovascularization with simultaneous eye-tracked spectral-domain optical coherence tomography and high-speed real-time angiography

Abstract

Purpose: To analyze the multimodal imaging features of eyes with early Type 3 neovascularization showing primarily intraretinal proliferation without evidence of choroidal involvement.

Methods: The multimodal imaging data for a consecutive series of patients with new onset stage 1 Type 3 neovascularization were reviewed and the changes at the site of early lesion development were analyzed.

Results: Nineteen eyes of 19 patients (12 women, mean age 79.9 ± 6.3 years) were included for analysis. Both fluorescein angiography and indocyanine green angiography showed a focal hyperfluorescence corresponding to the intraretinal vascular complex (early Type 3 neovascularization) and disclosed a single retinal arteriole feeding this lesion. There was no angiographic evidence of a retinal-choroidal anastomosis or underlying Type 1 or Type 2 neovascularization. In all study eyes, eye-tracked spectral-domain optical coherence tomography showed the intraretinal neovascular complex as a hyperreflective lesion located in the outer retina, which appeared adherent to the underlying retinal pigment epithelium. In all eyes, there seemed to be a focal discontinuity of the retinal pigment epithelium band through which the hyperreflective intraretinal lesions communicated with the underlying material of medium reflectivity within drusen or drusenoid pigment epithelium detachment. With spectral-domain optical coherence tomography, clear evidence of a communication with the choroid was not detected.

Conclusion: Multimodal imaging seems to support available clinicopathologic findings showing primarily intraretinal proliferation and anastomoses between retinal vessels and evolving Type 1 (subretinal pigment epithelium) neovascular tissue within underlying drusen or drusenoid pigment epithelium detachments without evidence of anastomoses with the choroidal circulation.