Non-indocyanine green angiography non-invasive differentiating features in the differential diagnosis of pachychoroid neovasculopathy and neovascular age-related macular degeneration: a sensitivity-specificity study.

OBJECTIVES

To define the differentiating features of pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) without dye angiography.

METHODS

This study included treatment-naive 50 PNV patients and 50 nAMD patients with unilateral Type 1 macular neovascularisation (MNV). The studied optical coherence tomography (OCT) features were subretinal hyperreflective material, intraretinal cysts, choroidal thickness (CT), pigment epithelial detachment (PED), retinal pigment epithelium (RPE) changes, and types of drusen. The choroidal vascularity index (CVI) was calculated. Intervortex venous anastomosis, MNV subtypes, and the main trunk appearance on OCT angiography (OCTA) were evaluated. Features with an area under the receiver operating characteristic curve (AUC) above 0.75 were defined as major, while those between 0.60 and 0.75 were defined as minor differentiating features.

RESULTS

Five features met the criteria for major differentiating features: age ≤60 years, SFCT ≥ 254 µm in the diseased eye, CVI ≥ 72% in the diseased eye, SFCT ≥ 323 µm in the fellow eye, and the absence of soft drusen. Six features met the criteria for minor differentiating features: CVI ≥ 74% in the fellow eye, absence of serous PED, absence of reticular drusen, presence of intervortex anastomoses, presence of immature MNV, and absence of the main trunk on OCTA. The sensitivity, specificity, positive predictive value, negative predictive value, and AUC for at least three major and at least three minor differentiating features are 0.88, 0.96, 0.96, 0.89, and 0.92, respectively.

CONCLUSION

At least three major and three minor criteria must be present to confidently diagnose PNV.