Purpose: To report features of neovascular age-related macular degeneration (AMD) in Brazilian patients. Procedures: Data were prospectively collected from patients diagnosed with neovascular AMD. Eyes were classified as having typical neovascular AMD, polypoidal choroidal vasculopathy (PCV), or retinal angiomatous proliferation (RAP). Results: In total, 265 eyes of 207 patients of predominantly Caucasian ancestry were included; 166 (62.6%) eyes had typical neovascular AMD, 65 (24.5%) eyes had PCV, and 34 (12.8%) eyes had RAP. RAP demonstrated a higher percentage of bilateral cases (p = 0.015). The mean foveal subfield thickness was significantly lower in eyes with PCV (p < 0.001). Cases with typical neovascular AMD had a higher percentage of predominantly classic and minimally classic lesions on fluorescein angiography (FA; p = 0.005). Conclusions: In Brazilian patients, PCV and RAP represented 24.5 and 12.8% of neovascular AMD cases. Neovascular AMD subtypes differ in relation to clinical features, mean foveal subfield thickness and FA presentation.

1.
Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, Mariotti SP: Global data on visual impairment in the year 2002. Bull World Health Organ 2004;82:844-851.
2.
Ferris FL, Wilkinson CP, Bird A, Chakravarthy U, Chew E, Csaky K, Sadda SR: Clinical classification of age-related macular degeneration. Ophthalmology 2013;120:844-851.
3.
Macular Photocoagulation Study Group: Laser photocoagulation of subfoveal recurrent neovascular lesions in age-related macular degeneration. Results of a randomized clinical trial. Arch Ophthalmol 1991;109:1232-1241.
4.
Macular Photocoagulation Study Group: Subfoveal neovascular lesions in age-related macular degeneration. Guidelines for evaluation and treatment in the macular photocoagulation study. Arch Ophthalmol 1991;109:1242-1257.
5.
Yannuzzi LA, Ciardella A, Spaide RF, Rabb M, Freund KB, Orlock DA: The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 1997;115:478-485.
6.
Yannuzzi LA, Negrao S, Iida T, Carvalho C, Rodriguez-Coleman H, Slakter J, Freund KB, Sorenson J, Orlock D, Borodoker N: Retinal angiomatous proliferation in age-related macular degeneration. Retina 2001;21:416-434.
7.
Liakopoulos S, Ongchin S, Bansal A, Msutta S, Walsh AC, Updike PG, Sadda SR: Quantitative optical coherence tomography findings in various subtypes of neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci 2008;49:5048-5054.
8.
Maruko I, Iida T, Saito M, Nagayama D, Saito K: Clinical characteristics of exudative age-related macular degeneration in Japanese patients. Am J Ophthalmol 2007;144:15-22.
9.
Takahashi K, Ishibashi T, Ogur Y, Yuzawa M: Classification and diagnostic criteria of age-related macular degeneration (in Japanese). Nihon Ganka Gakkai Zasshi 2008;112:1076-1084.
10.
Singerman LJ, Brucker AJ, Jampol LM, Lim JI, Rosenfeld P, Schachat AP, Spaide RF: Neovascular age-related macular degeneration: roundtable. Retina 2005;25(7 suppl):S1-S22.
11.
Moorthy RS, Lyon AT, Rabb MF, Spaide RF, Yannuzzi LA, Jampol LM: Idiopathic polypoidal choroidal vasculopathy of the macula. Ophthalmology 1998;105:1380-1385.
12.
Koh AH, Chen LJ, Chen SJ, Chen Y, Giridhar A, Iida T, Kim H, Yuk Yau Lai T, Lee WK, Li X, Han Lim T, Ruamviboonsuk P, Sharma T, Tang S, Yuzawa M: Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment. Retina 2013;33:686-716.
13.
Swaroop A, Branham KE, Chen W, Abecasis G: Genetic susceptibility to age-related macular degeneration: a paradigm for dissecting complex disease traits. Hum Mol Genet 2007;16(spec No 2):R174-R182.
14.
Almeida LN, Melilo-Carolino R, Veloso CE, Pereira PA, Bastos-Rodrigues L, Sarubi H, Miranda DM, Soubrane G, De Marco L, Nehemy MB: Association analysis of CFH and ARMS2 gene polymorphisms in a Brazilian cohort with age-related macular degeneration. Ophthalmic Res 2013;50:117-122.
15.
Almeida LN, Melilo-Carolino R, Veloso CE, Pereira PA, Miranda DM, De Marco LA, Nehemy MB: Homozygosity for the +674C>T polymorphism on VEGF gene is associated with age-related macular degeneration in a Brazilian cohort. Graefes Arch Clin Exp Ophthalmol 2012;250:185-189.
16.
Teixeira AG, Silva AS, Lin FL, Velletri R, Bavia L, Belfort R Jr, Isaac L: Association of complement factor H Y402H polymorphism and age-related macular degeneration in Brazilian patients. Acta Ophthalmol 2010;88:e165-e169.
17.
Lima LH, Schubert C, Ferrara DC, Merriam JE, Imamura Y, Freund KB, Spaide RF, Yannuzzi LA, Allikmets R: Three major loci involved in age-related macular degeneration are also associated with polypoidal choroidal vasculopathy. Ophthalmology 2010;117:1567-1570.
18.
Vanderbeek BL, Zacks DN, Talwar N, Nan B, Musch DC, Stein JD: Racial differences in age-related macular degeneration rates in the United States: a longitudinal analysis of a managed care network. Am J Ophthalmol 2011;152:273-282.e3.
19.
Byeon SH, Lee SC, Oh HS, Kim SS, Koh HJ, Kwon OW: Incidence and clinical patterns of polypoidal choroidal vasculopathy in Korean patients. Jpn J Ophthalmol 2008;52:57-62.
20.
Parra FC, Amado RC, Lambertucci JR, Rocha J, Antunes CM, Pena SD: Color and genomic ancestry in Brazilians. Proc Natl Acad Sci USA 2003;100:177-182.
21.
Barbazetto I, Burdan A, Bressler NM, Bressler SB, Haynes L, Kapetanios AD, Lukas J, Olsen K, Potter M, Reaves A, Rosenfeld P, Schachat AP, Strong HA, Wenkstern A: Photodynamic therapy of subfoveal choroidal neovascularization with verteporfin: fluorescein angiographic guidelines for evaluation and treatment - TAP and VIP report No. 2. Arch Ophthalmol 2003;121:1253-1268.
22.
Seddon JM, Sharma S, Adelman RA: Evaluation of the clinical age-related maculopathy staging system. Ophthalmology 2006;113:260-266.
23.
Yannuzzi LA, Wong DW, Sforzolini BS, Goldbaum M, Tang KC, Spaide RF, Freund KB, Slakter JS, Guyer DR, Sorenson JA, Fisher Y, Maberley D, Orlock DA: Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration. Arch Ophthalmol 1999;117:1503-1510.
24.
Coscas G, Yamashiro K, Coscas F, De Benedetto U, Tsujikawa A, Miyake M, Gemmy Cheung CM, Wong TY, Yoshimura N: Comparison of exudative age-related macular degeneration subtypes in Japanese and French patients: multicenter diagnosis with multimodal imaging. Am J Ophthalmol 2014;158:309-318.
25.
Ilginis T, Ottosen S, Harbo Bundsgaard K, Uggerhoj Andersen C, Vorum H: Polypoidal choroidal vasculopathy in patients diagnosed with neovascular age-related macular degeneration in Denmark. Acta Ophthalmol 2012;90:e487-e488.
26.
Ladas ID, Rouvas AA, Moschos MM, Synodinos EE, Karagiannis DA, Koutsandrea CN: Polypoidal choroidal vasculopathy and exudative age-related macular degeneration in Greek population. Eye (Lond) 2004;18:455-459.
27.
Scassellati-Sforzolini B, Mariotti C, Bryan R, Yannuzzi LA, Giuliani M, Giovannini A: Polypoidal choroidal vasculopathy in Italy. Retina 2001;21:121-125.
28.
Wen F, Chen C, Wu D, Li H: Polypoidal choroidal vasculopathy in elderly Chinese patients. Graefes Arch Clin Exp Ophthalmol 2004;242:625-629.
29.
Sho K, Takahashi K, Yamada H, Wada M, Nagai Y, Otsuji T, Nishikawa M, Mitsuma Y, Yamazaki Y, Matsumura M, Uyama M: Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol 2003;121:1392-1396.
30.
Owens SL: Indocyanine green angiography. Br J Ophthalmol 1996;80:263-266.
31.
Kokame GT: Polypoidal choroidal vasculopathy - an important diagnosis to make with therapeutic implications. Retina 2012;32:1446-1448.
32.
Arai K, Kawamura A, Yuzawa M: Retinal angiomatous proliferation in age-related macular degeneration (in Japanese). Folia Ophthalmol Jpn 2003;54:513-518.
33.
Liu Y, Wen F, Huang S, Luo G, Yan H, Sun Z, Wu D: Subtype lesions of neovascular age-related macular degeneration in Chinese patients. Graefes Arch Clin Exp Ophthalmol 2007;245:1441-1445.
34.
Cohen SY, Creuzot-Garcher C, Darmon J, Desmettre T, Korobelnik JF, Levrat F, Quentel G, Palies S, Sanchez A, de Gendre AS, Schluep H, Weber M, Delcourt C: Types of choroidal neovascularisation in newly diagnosed exudative age-related macular degeneration. Br J Ophthalmol 2007;91:1173-1176.
35.
George S, Cooke C, Chakravarthy U: Exudative AMD subtypes and eligibility for treatment with ranibizumab. Eye 2010;24:1247-1251.
36.
Jung JJ, Chen CY, Mrejen S, Gallego-Pinazo R, Xu L, Marsiglia M, Boddu S, Freund KB: The incidence of neovascular subtypes in newly diagnosed neovascular age-related macular degeneration. Am J Ophthalmol 2014;158:769-779.e2.
37.
Rudnicka AR, Jarrar Z, Wormald R, Cook DG, Fletcher A, Owen CG: Age and gender variations in age-related macular degeneration prevalence in populations of European ancestry: a meta-analysis. Ophthalmology 2012;119:571-580.
38.
Smith W, Assink J, Klein R, Mitchell P, Klaver CC, Klein BE, Hofman A, Jensen S, Wang JJ, de Jong PT: Risk factors for age-related macular degeneration: pooled findings from three continents. Ophthalmology 2001;108:697-704.
39.
Age-Related Eye Disease Study Research Group: Risk factors associated with age-related macular degeneration. A case-control study in the age-related eye disease study: Age-Related Eye Disease Study Report Number 3. Ophthalmology 2000;107:2224-2232.
40.
Kwok AK, Lai TY, Chan CW, Neoh El, Lam DS: Polypoidal choroidal vasculopathy in Chinese patients. Br J Ophthalmol 2002;86:892-897.
41.
Lafaut BA, Leys AM, Snyers B, Rasquin F, De Laey JJ: Polypoidal choroidal vasculopathy in Caucasians. Graefes Arch Clin Exp Ophthalmol 2000;238:752-759.
42.
Gross NE, Aizman A, Brucker A, Klancnik JM Jr, Yannuzzi LA: Nature and risk of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation. Retina 2005;25:713-718.
43.
Moreira JP, Moraes JR, Luiz RR: Prevalence of self-reported systemic arterial hypertension in urban and rural environments in Brazil: a population-based study. Cad Saude Publica 2013;29:62-72.
44.
Ueta T, Obata R, Inoue Y, Iriyama A, Takahashi H, Yamaguchi T, Tamaki Y, Yanagi Y: Background comparison of typical age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients. Ophthalmology 2009;116:2400-2406.
45.
Hoerster R, Muether PS, Sitnilska V, Kirchhof B, Fauser S: Fibrovascular pigment epithelial detachment is a risk factor for long-term visual decay in neovascular age-related macular degeneration. Retina 2014;34:1767-1773.
46.
Ozawa S, Ishikawa K, Ito Y, Nishihara H, Yamakoshi T, Hatta Y, Terasaki H: Differences in macular morphology between polypoidal choroidal vasculopathy and exudative age-related macular degeneration detected by optical coherence tomography. Retina 2009;29:793-802.
47.
Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, Lai TY, Pilz S, Ruamviboonsuk P, Tokaji E, Weisberger A, Lim TH; EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina 2012;32:1453-1464.
48.
Hatz K, Prunte C: Polypoidal choroidal vasculopathy in Caucasian patients with presumed neovascular age-related macular degeneration and poor ranibizumab response. Br J Ophthalmol 2014;98:188-194.
49.
Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Lanchulev T: Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study. Ophthalmology 2009;116:57-65.e5.
50.
Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, Kirchhof B, Ho A, Ogura Y, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Groetzbach G, Sommerauer B, Sandbrink R, Simader C, Schmidt-Erfurth U: Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 2012;119:2537-2548.
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