Clinical Characteristics of Punctate Hyperfluorescence Spots in the Fellow Eye of Patients with Unilateral Macular Neovascularization with No Drusen

<b>Objectives</b>: To assess the clinical characteristics of patients with macular neovascularization (MNV) with no drusen in the fellow eye, we investigated the incidence of MNV in fellow eyes and the outcomes of intravitreal aflibercept (IVA) monotherapy in MNV eyes of patients with unilateral MNV with a punctate hyperfluorescence spot (PHS) in the fellow eye. <b>Methods</b>: We retrospectively studied 58 treatment-naïve patients with unilateral MNV with no drusen in the fellow eye. Patients were classified into a PHS group (<i>n</i> = 29) or no-PHS group (<i>n</i> = 29) based on the presence of PHS. We evaluated the incidence of MNV in the fellow eye, and the retreatment rate after initiation of three monthly aflibercept injections over one year. <b>Results</b>: Fellow eyes in the PHS group had a thicker choroid (<i>p</i> < 0.05) and higher prevalence of pachychoroid pigment epitheliopathy (PPE) (<i>p</i> < 0.001). MNV eyes in the PHS group had a thicker choroid (<i>p</i> = 0.09). The PHS group had a lower retreatment rate (<i>p</i> < 0.05) and required fewer injections (<i>p</i> < 0.05) than the no-PHS group. MNV developed in one eye in both the PHS and no-PHS groups, and both cases occurred in areas of hypofluorescence on indocyanine green angiography within the PPE area before the onset of MNV. <b>Conclusions</b>: The PHS group frequently exhibited pachychoroid disease characteristics and responded better to IVA monotherapy than the no-PHS group. These groups may represent distinct populations of patients with unilateral MNV with no drusen in the fellow eye.