Type 3 neovascularization: Evolution, association with pigment epithelial detachment, and treatment response as revealed by spectral domain optical coherence tomography

Aaron Nagiel, David Sarraf, Srinivas R. Sadda, Richard F. Spaide, Jesse J. Jung, Kavita V. Bhavsar, Hossein Ameri, Giuseppe Querques, K. Bailey Freund

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

Purpose: To demonstrate the evolution and treatment response of Type 3 neovascularization using spectral domain optical coherence tomography. Methods: We retrospectively analyzed 40 eyes treated with intravitreal anti-vascular endothelial growth factor therapy for Type 3 neovascularization over a variable follow-up period. Results: In 17 eyes, spectral domain optical coherence tomography captured the development of Type 3 neovascularization from punctate hyperreflective foci that preceded any outer retinal defect. The more mature Type 3 lesions were associated with outer retinal disruption and adjacent cystoid macular edema. In addition, 37 of 40 Type 3 lesions (93%) were associated with an underlying pigment epithelial detachment, of which 26 (70%) were drusenoid, 6 (16%) serous, and 5 (14%) mixed. Type 3 vessels appeared to leak fluid into the pigment epithelial detachment cavity, creating serous pigment epithelial detachments as large as 925 m in maximal height. Treatment with anti-vascular endothelial growth factor agents led to prompt involution of the lesion and resorption of the intraretinal and subretinal pigment epithelium fluid after one or two injections (median 1). Conclusion: In some eyes with age-related macular degeneration, the earliest sign of Type 3 neovascularization is punctate hyperreflective foci above the external limiting membrane. The mature Type 3 lesions and associated serous pigment epithelial detachments are highly responsive to anti-vascular endothelial growth factor therapy.

Original languageEnglish (US)
Pages (from-to)638-647
Number of pages10
JournalRetina
Volume35
Issue number4
DOIs
StatePublished - Apr 1 2015

Keywords

  • Type 3 neovascularization
  • age-related macular degeneration
  • hyperreflective foci
  • optical coherence tomography
  • pigment epithelial detachment
  • retinal angiomatous proliferation
  • vascular endothelial growth factor

ASJC Scopus subject areas

  • Ophthalmology

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