Good Hope, Heartlands, and Solihull Eye Clinics

Occult with PED type of wet ARMD

David Kinshuck

CNV type 1

type 1 cnv

type 1 CNV

In this type of ARMD, there are new blood vessels, but they are not clearly seen with the angiogram. 'Occult' CNV is the term given to a specific 'blotchy' appearance of the angiogram. This type of CNV probably an early phase of classic, see . Occult and classic patterns can occur together. Anti-VEGF drugs generally help. The symptoms of this type of CNV are the same as 'classic CNV', except the condition takes longer to develop. Without treatment, this type of CNV usually turns into classic CNV over the next months or years, to cause poor central vision.

  • Large type 1 CNV membranes can develop haemorrhages with anti-VEGF treatment (BJO 2008).
  • photo   another   another..occult/mixed    another   flash   another    large diagram
  • The term occult is not really used now: the condition is a subtype of wet armd sometimes termed type 1 CNV.
  • Sometimes there is a hyper-reflective material which is related to prognosis, and to pachychoroidopathy (= thickened choroid).
  • Sometimes there is fluid, but if the fluid is stable injections don't seem to help.
  • This is similar to the type 1 CNV below, the difference being there is no PED

CNV type 1 with a vascularised PED

In this ttype of CNV there is a PED (pigment epithelial detachment)

 

 

occult cnv with a PED (a type of macular degenerationa PED..pigment epithelial detachment, with CNV (choroidal neovascularisation): type 1 with a PED. This condition usually progresses, but progression rates are very variable.

 

In this type of wet ARMD the damaged area looks like a dome, but in addition fluid leaks under the retina, hence the term 'wet'.

Anti-VEGF drugs generally help. The PED may reduce in size with treatment, and treatment will reduce intraretinal and subretinal fluid. Retina 2011. Occasionally the retina may 'rip', causing more loss of sight Eye 2011. Overall, 15% of PEDs rip, but the risk is proportional to the PED size, so a large PED is much more likely to rip. About of 8% of patients may develop worse sight with treatment Retina 17. The rip typically occurs 2 months after starting treatment. The rip may not cause that much visual loss initially, but central vision may get worse over time.

 

a vascularised PED (a type of wet ARMD)

November, 7 months later, a PED has developed, with a retinal haemorrhage. Also, intraretinal and subretinal fluid.

Patient, age 86, April, reasonable vision 6/24 Photo / OCT show drusen, hard and soft enlarge

Professionals

  • ARMD with a PED is classified as 'occult' CNV, type 1.  Outcomes Eye 11
  • Look for polyps,    see   PCV.
  • photo  case 9 r/l     left     case.
  • There are 3 types of PED, reviewed here (avascular, occult, polypoidal). 
  • photo avascular PED
  • intraretinal cysts indicate a poorer response BJO14
  • combined with geographic atrophy BJO 14
  • treatment helps stabilize/improve SIO 15
  • fluid fluctuates with injections every 2 months
  • serous PEDs respond better Retina 16; switich antiVEGF if response poor.
  • incomplete response to antiVEGF AJO 16    Vriable response  Retina 17