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Non-indocyanine green angiography non-invasive differentiating features in the differential diagnosis of pachychoroid neovasculopathy and neovascular age-related macular degeneration: a sensitivity-specificity study

Eye (2025)Cite this article

Subjects

Abstract

Objectives

To define the differentiating features of pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) without dye angiography.

Methods

This study included treatment-naive 50 PNV patients and 50 nAMD patients with unilateral Type 1 macular neovascularisation (MNV). The studied optical coherence tomography (OCT) features were subretinal hyperreflective material, intraretinal cysts, choroidal thickness (CT), pigment epithelial detachment (PED), retinal pigment epithelium (RPE) changes, and types of drusen. The choroidal vascularity index (CVI) was calculated. Intervortex venous anastomosis, MNV subtypes, and the main trunk appearance on OCT angiography (OCTA) were evaluated. Features with an area under the receiver operating characteristic curve (AUC) above 0.75 were defined as major, while those between 0.60 and 0.75 were defined as minor differentiating features.

Results

Five features met the criteria for major differentiating features: age ≤60 years, SFCT ≥ 254 µm in the diseased eye, CVI ≥ 72% in the diseased eye, SFCT ≥ 323 µm in the fellow eye, and the absence of soft drusen. Six features met the criteria for minor differentiating features: CVI ≥ 74% in the fellow eye, absence of serous PED, absence of reticular drusen, presence of intervortex anastomoses, presence of immature MNV, and absence of the main trunk on OCTA. The sensitivity, specificity, positive predictive value, negative predictive value, and AUC for at least three major and at least three minor differentiating features are 0.88, 0.96, 0.96, 0.89, and 0.92, respectively.

Conclusion

At least three major and three minor criteria must be present to confidently diagnose PNV.

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Fig. 1: Demostration of differences in choroidal vascular structures between two distinct patients, one with pachychoroid neovascupathy (PNV) and the other age-related macular degeneration (AMD), using multimodal imaging.
Fig. 2: Results of the receiver operating characteristic (ROC) curve analysis to define major differentiating features regarding the diagnosis of pachychoroid neovasculopathy.

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Data availability

The datasets generated during and /or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey

    Sibel Demirel, Pınar Aydın Ellialtıoğlu, Özge Yanık & Figen Batıoğlu

  2. Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore

    Chui Ming Gemmy Cheung

  3. Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA

    Jay Chhablani

  4. Eye & Retina Surgeons, Camden Medical Center, Singapore, Singapore

    Adrian Koh

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Contributions

SD was responsible for designing the protocol, writing the protocol and report, conducting the research, extracting and analysing data, interpreting results, writing. PAE contributed to writing the report, extracting and analysing data, interpreting results, and creating figures and tables. OY conducted the analyses and contributed to the design of the protocol. CG, JC and AK were drafting the work or reviewing it critically for important intellectual content. FB was responsible for designing the protocol and provided feedback on the report.

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Correspondence to Sibel Demirel.

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The authors received no financial support for the research, authorship, and/or publication of this article. CMGC is a member of the Eye editorial board.

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Demirel, S., Ellialtıoğlu, P.A., Yanık, Ö. et al. Non-indocyanine green angiography non-invasive differentiating features in the differential diagnosis of pachychoroid neovasculopathy and neovascular age-related macular degeneration: a sensitivity-specificity study. Eye (2025). https://doi.org/10.1038/s41433-025-04039-y

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