First Author: A.Grigorieva RUSSIA
Co Author(s): T. Iureva S. Zhukova N. Zaitseva A. Shchuko
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To identify and systematize the differential diagnostic features of chorioretinal neovascularization in complicated myopia and exudative age-related macular degeneration.
Irkutsk Branch of Sv. Fyodorov Eye Microsurgery Institute, Irkutsk, Russia
40 patients with chorioretinal neovascularization aged from 23 to 78 years were examined. Taking into account the aetiology, patients were divided into two groups. The first group included 20 patients with complicated myopia. The second group consists of 20 patients with exudative age-related macular degeneration. Fluorescent angiography and optical coherence tomography data were used as the main criterion for diagnostics of subretinal neovascular membrane, determination of degree of its activity and indications for treatment with inhibitors of angiogenesis. When revealing signs of membrane activity, intravitreal administration of inhibitors of angiogenesis was performed. The follow-up period was 2 years.
Group of patients with myopic chorioretinal neovascularization was predominantly represented by women (91.8%) aged 35±8.12 years. Ratio of women and men in second group was 1:1, older persons predominated (69±7.9 years). Patients of first group had classical subretinal neovascular membrane located above retinal pigment epithelium, patients with age-related macular degeneration, in approximately 59% of cases, had mixed neovascularization with predominant localization of vessels under pigment epithelium. Features of neovascularization in complicated myopia are moderate activity, small membrane sizes (horizontal - 568±111.5, vertical - 205±28.6, sagittal - 316±31.3 microns), and absence of exudation over pathological foci. In patients with age-related macular degeneration, the shape and size of the neovascularization differed from the parameters in myopic chorioretinal neovascularization: horizontal was more 3.8 times -2132.5±396.8; vertical - more by 30-50 microns -224±57.8; sagittal was less in 1,6 times-198±49,3 microns. Damage to neuroepithelium and pigment epithelium, pronounced exudation over subretinal neovascular membrane and along its margin were determined. To achieve remission in complicated myopia, an average of 1.4 ± 0.7 injections of inhibitors of angiogenesis was required, which is 3 times less than in age-related macular degeneration - 3.5±2.1.
Differential diagnostic criteria of myopic chorioretinal neovascularization: moderate activity, small size of the focus, absence of exudation over pathological foci. Newly formed vessels form compact conglomerates in the form of a ball with a hypo-intensive halo around the periphery. The OCT-A method expands the possibilities in studying the pathogenesis of diseases, which are based on disorders of the chorioretinal blood flow.