Abstract
Background
To compare the characteristics of type 1 macular neovascularization (MNV) and the surrounding choriocapillaris (CC) perfusion in patients with neovascular age-related macular degeneration (nAMD) versus those with pachychoroid neovasculopathy (PNV) using swept-source optical coherence tomography angiography (SS-OCTA).
Methods
This retrospective study included 64 treatment-naïve eyes (37 nAMD, 27 PNV) with type 1 MNV. SS-OCTA images were analysed to measure MNV area and perimeter, and CC flow deficits (FD) in five concentric rings surrounding the lesion. CC FD percentage (FD%), area (FDa), and number (FDn) were quantified. Intervortex anastomoses presence was also assessed.
Results
MNV lesions in nAMD were significantly larger in area (2.94 vs 1.56 mm², p = 0.013) and perimeter (8.76 vs 5.85 mm, p = 0.004) compared to PNV. PNV eyes showed higher FD% and larger FDa across all rings (p < 0.05), while FDn did not differ significantly. Intervortex anastomoses were more prevalent in PNV (81.5% vs 35.1%, p = 0.0002). In nAMD, MNV size correlated positively with FD% in inner rings and FDn in all rings. In PNV, MNV size correlated only with FDn.
Conclusions
Despite smaller MNV lesions, PNV eyes demonstrated more extensive CC flow deficits compared to nAMD. The distinct CC flow patterns and their correlations with MNV characteristics suggest different pathophysiological mechanisms underlying these conditions. These findings may have implications for differential diagnosis and tailored treatment approaches in nAMD and PNV.
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Data availability
The datasets generated and analysed during the current study are not publicly available due to privacy concerns and regulations regarding patient data protection, but de-identified data are available from the corresponding author upon reasonable request and with appropriate institutional review board approval.
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PV conceived the study, performed data analysis, and drafted the manuscript. SD contributed to study design and critically revised the manuscript. GP and MP were involved in data collection and interpretation. EB and MR provided expertise in image analysis and contributed to the interpretation of results. GB and GA contributed to patient recruitment and data collection. JC and FB supervised the study, provided critical feedback, and helped shape the research and analysis. All authors reviewed and approved the final version of the manuscript.
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Viggiano, P., Demirel, S., Petruzzella, G. et al. Choriocapillaris flow in two different patterns of exudative type 1 macular neovascularization. Eye 39, 556–562 (2025). https://doi.org/10.1038/s41433-024-03587-z
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DOI: https://doi.org/10.1038/s41433-024-03587-z
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