title: Type 3 neovascularization: evolution, association with pigment epithelial detachment, and treatment response as revealed by spectral domain optical coherence tomography.
abstract: OBJECTIVE
  To demonstrate the evolution and treatment response of Type 3 neovascularization using spectral domain optical coherence tomography.
  
  
  METHODS
  We retrospectively analyzed 40 eyes treated with intravitreal anti-vascular endothelial growth factor therapy for Type 3 neovascularization over a variable follow-up period.
  
  
  RESULTS
  In 17 eyes, spectral domain optical coherence tomography captured the development of Type 3 neovascularization from punctate hyperreflective foci that preceded any outer retinal defect. The more mature Type 3 lesions were associated with outer retinal disruption and adjacent cystoid macular edema. In addition, 37 of 40 Type 3 lesions (93%) were associated with an underlying pigment epithelial detachment, of which 26 (70%) were drusenoid, 6 (16%) serous, and 5 (14%) mixed. Type 3 vessels appeared to leak fluid into the pigment epithelial detachment cavity, creating serous pigment epithelial detachments as large as 925 μm in maximal height. Treatment with anti-vascular endothelial growth factor agents led to prompt involution of the lesion and resorption of the intraretinal and subretinal pigment epithelium fluid after one or two injections (median = 1).
  
  
  CONCLUSIONS
  In some eyes with age-related macular degeneration, the earliest sign of Type 3 neovascularization is punctate hyperreflective foci above the external limiting membrane. The mature Type 3 lesions and associated serous pigment epithelial detachments are highly responsive to anti-vascular endothelial growth factor therapy.
authors: *Division of Retinal Disorders and Ophthalmic Genetics, Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles Geffen School of Medicine, Los Angeles, California; †Department of Surgery, Greater Los Angeles Veteran's Administration Healthcare Center, Los Angeles, California; ‡Department of Ophthalmology, Kaiser Permanente, Woodland Hills, California; §Doheny Eye Institute, Department of Ophthalmology, University of California, Los Angeles Geffen School of Medicine, Los Angeles, California; ¶University of Southern California Eye Institute, Department of Ophthalmology, Keck School of Medicine, Los Angeles, California; **Vitreous-Retina-Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; ††Department of Ophthalmology, New York University School of Medicine, New York, New York; ‡‡Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, New York; and §§Department of Ophthalmology, University Paris XII, Center Intercommunal de Creteil, Creteil, France.
authors: Aaron
authors: A
authors: Nagiel
authors: David
authors: D
authors: Sarraf
authors: Srinivas R
authors: SR
authors: Sadda
authors: Richard F
authors: RF
authors: Spaide
authors: Jesse J
authors: JJ
authors: Jung
authors: Kavita V
authors: KV
authors: Bhavsar
authors: Hossein
authors: H
authors: Ameri
authors: Giuseppe
authors: G
authors: Querques
authors: K Bailey
authors: KB
authors: Freund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D058449:Intravitreal Injections; D008297:Male; D010211:Papilledema / Q000175:diagnosis* / Q000188:drug therapy; D012163:Retinal Detachment / Q000175:diagnosis* / Q000188:drug therapy; D015861:Retinal Neovascularization / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy / Q000473:pathology*
chemical_list: D020533:Angiogenesis Inhibitors; D004396:Coloring Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D007208:Indocyanine Green