Pachychoroid Neovasculopathy Often Misdiagnosed as Wet Age-Related Macular Degeneration

Consider pachychoroid neovasculopathy as a differential before diagnosing with neovascular AMD.

Patients with pachychoroid neovasculopathy (PNV) are frequently misdiagnosed with wet age-related macular degeneration (AMD), according to research published in the International Journal of Retina and Vitreous.

Researchers conducted a retrospective cross-sectional study to determine the percentage of patients with PNV who had been misdiagnosed with wet AMD.

The team identified all patients treated at a single center who were older than 55 years and had a diagnosis of wet AMD. They recalled all patients to undergo complete ophthalmological re-examination, including enhanced depth imaging-optical coherence tomography, and differentiated wet AMD and PNV based on the findings of the re-examination.

A total of 137 eyes of 120 patients were diagnosed with wet AMD in the clinic. With re-examination, the researchers reported that 106 eyes of 94 patients were diagnosed with AMD and 31 eyes of 26 patients were diagnosed with PNV, meaning 20% of patients with an initial diagnosis of wet AMD actually had PNV. 

This study revealed that about one-fifth of wet AMD patients were actually pachychoroid neovasculopathy and often were misdiagnosed. These patients were younger and developed less subretinal scarring. Thus, the disorder must be considered an important differential diagnosis of AMD-[choroidal neovascularization].

The team found a mean subfield choroidal thickness of 173.8±69 μm in the AMD group and 342±27 μm in the PNV group (P <.001). They observed the presence of drusen and pachydrusen in 69.9% of cases with AMD and 24% of cases with PNV (P =.001). They also found that the average number of required intravitreal injections of anti-vascular endothelial growth factor was significantly higher in the AMD group than in the PNV group (5 vs 3; P =.02).

“This study revealed that about one-fifth of wet AMD patients were actually pachychoroid neovasculopathy and often were misdiagnosed. These patients were younger and developed less subretinal scarring. Thus, the disorder must be considered an important differential diagnosis of AMD-[choroidal neovascularization],” according to the researchers.

Limitations of the study included the retrospective, cross-sectional design, relatively small sample sizes, and inability to perform indocyanine green angiography due to the unavailability of an indocyanine green dye.

References:

Farvardin M, Amini A, Azizpourfard Y, Yasemi M, Mahdizad Z, Johari M. Pachychoroid neovasculopathy can mimic wet type age-related macular degeneration. Int J Retina Vitreous. 2022;8(1):78. doi:10.1186/s40942-022-00429-6