Assessing the long-term evolution of type 3 neovascularization in age-related macular degeneration using optical coherence tomography angiography

Graefes Arch Clin Exp Ophthalmol. 2021 Sep;259(9):2605-2613. doi: 10.1007/s00417-021-05163-7. Epub 2021 Mar 21.


Purpose: To analyze the evolution of type 3 neovascularization in eyes with age-related macular degeneration during anti-vascular endothelial growth factor (VEGF) treatment using optical coherence tomography angiography (OCTA) analysis.

Methods: Forty-one treatment-naïve eyes (37 patients) with type 3 neovascularization were retrospectively included in the study. The growth and morphological changes in the type 3 lesions, which were recorded using OCTA, were compared across time.

Results: The high-flow signal of the lesion on OCTA was significantly increased at the sub-retinal pigment epithelium (RPE) and the choriocapillaris during anti-VEGF treatment. The detection rate of the flow signal in the sub-RPE increased from 50.0% at baseline and 51.2% at 12 months to 65.9% at 24 months (P = 0.013). The flow signal extending into the choriocapillaris was detected in 0% of the eyes at baseline, 9.8% of the eyes at 12 months, and 17.1% of the eyes at 24 months (P = 0.018). The presence of subretinal drusenoid deposits (SDD) was significantly more frequent in the group with extension into the choriocapillaris (100%) than in the group without (61.8%, P = 0.036). For the four eyes with extension into the choroid, the morphological feature of the lesion on en face OCTA evolved into a tangled vascular network, similar to type 1 neovascularization.

Conclusion: OCTA analysis revealed that type 3 neovascularization gradually extended downward toward the sub-RPE and choroid during anti-VEGF treatment. The extension of the lesion into the choriocapillaris, suggesting retinal-choroidal anastomosis, was significantly more frequent in eyes with SDD.

Keywords: Age-related macular degeneration; Choroidal neovascularization; Optical coherence tomography angiography; Retinal angiomatous proliferation; Type 3 neovascularization; Vascular endothelial growth factor.

MeSH terms

  • Choroid
  • Choroidal Neovascularization* / diagnosis
  • Choroidal Neovascularization* / drug therapy
  • Fluorescein Angiography
  • Humans
  • Macular Degeneration* / diagnosis
  • Macular Degeneration* / drug therapy
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Visual Acuity
  • Wet Macular Degeneration* / diagnosis
  • Wet Macular Degeneration* / drug therapy