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Additional classification type needed for CNV to reduce confusion, aid treatment
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HONG KONG — An additional classification type is necessary to better treat age-related macular degeneration patients and further clarify the differences in lesions, one surgeon said here. "Does lesion composition matter in the VEGF age? I believe it does," James Klancnik, MD, said during the Retina Subspecialty Day held prior to the World Ophthalmology Congress.
Dr. Klancnik said the current Gass classifications of type 1 and type 2 lesions do not cover all lesions seen by daily practitioners, and therefore, he proposed a third classification.
Type 3 lesions, he said, would be characterized by intraretinal neovascularization, retinal angiomatous proliferation with distinct clinical angiography of cystoid macular edema and retinal anastomoses.
Spectral domain optical coherence tomography allows today's surgeon to better visualize this new classification, he explained, showing that early monitoring revealed the retinal pigment epithelium (RPE) detachment appeared after the formation of retinal choroidal anastomosis.
"One of the nice things about this classification feature is it helps to remove the confusing natures of describing the neovascularization solely based on fluorescein angiography," he said. "Describing it in terms of its location — sub-RPE state, subretinally or intraretinally — I think is quite helpful. It also allows the description of mixed lesions."
Dr. Klancnik explained that these more detailed classifications also allow for the retina specialist to better estimate the course of anti-VEGF treatment and the visual results.
Type 1 lesions may require more frequent injections, but will produce better visual results, despite RPE detachments that do not flatten, as the retina is not damaged. Type 2 lesions will require less frequent injections, but produce poor visual results due to early damage, making early treatment critical. Type 3 lesions will require less frequent injections with a quick flattening of the RPE detachment if caught early, but poorer visual results will occur because vessels have invaded the retina.
"A revised anatomic classification might help reduce confusion associated with fluorescein based grading and may help guide treatment. Type 3 neovascularization is unique in that there is intraretinal proliferation and retinal choroidal anastomosis," Dr. Klancnik said.