title: Precursors of type 3 neovascularization: a multimodal imaging analysis.
abstract: OBJECTIVE
  To study the advent of exudative age-related macular degeneration in uninvolved fellow eyes of patients with unilateral Type 3 neovascularization and to investigate the precursors at the site of lesion development.
  
  
  METHODS
  We studied 37 consecutive patients with the diagnosis of unilateral Type 3 neovascularization, for the advent of exudative age-related macular degeneration in uninvolved fellow eyes (study eyes). Looking for the precursors of Type 3 neovascularization, we reviewed the multimodal imaging (fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography) in the study eyes and interpreted the changes over time at the site of lesion development.
  
  
  RESULTS
  Of the 37 patients, 12 (32%) developed exudative age-related macular degeneration in the study eye, after a mean of 19.6 ± 9.5 months (range, 9-36 months) from the diagnosis of Type 3 neovascularization in the first involved eye (baseline). All these patients (12 of 12 eyes; 100%) developed Type 3 neovascularization in the study eye. Retrospective analysis of the precursors of these lesions revealed, at baseline, a focal hyperautofluorescence (fundus autofluorescence) that turned to focal hypoautofluorescence over time. In all eyes, a focal hyperfluorescence (fluorescein angiography and indocyanine green angiography) appeared over time at the site of Type 3 neovascularization development. The corresponding spectral-domain optical coherence tomography showed a localized retinal pigment epithelial (RPE) elevation characterized by a focal disruption of the RPE and photoreceptors and by the overlying outer plexiform layer that progressively took contact with the RPE. Based on these findings, it seems that a small, localized RPE elevation might be the lesion before the development of Type 3 neovascularization. This precursor lesion progresses over time to focal atrophy of RPE and photoreceptor.
  
  
  CONCLUSIONS
  Type 3 neovascularization presents a predictable symmetry and bilaterality. Identification of the precursors of Type 3 neovascularization looks particularly useful for clinicians to detect the earliest changes in the vasogenic process in the fellow eye.
authors.affiliation: Department of Ophthalmology, University Paris XII, Centre Hospitalier Intercommunal de Creteil, Creteil, France. giuseppe.querques@hotmail.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
authors.forename: Lea
authors.initials: L
authors.lastname: Querques
authors.forename: Raimondo
authors.initials: R
authors.lastname: Forte
authors.forename: Nathalie
authors.initials: N
authors.lastname: Massamba
authors.forename: Rocio
authors.initials: R
authors.lastname: Blanco
authors.forename: Eric H
authors.initials: EH
authors.lastname: Souied
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D042241:Early Diagnosis; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D009887:Ophthalmoscopy / Q000379:methods; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000150:complications*
chemical_list: D007208:Indocyanine Green