Abstract
PurposeThe aim of this study was to find out whether the vascular architecture of untreated macular neovascularisations (MNV) in neovascular age-related macular degeneration (nAMD) as visualised with optic coherence tomography angiography (OCTA) is associated with functional and known morphological alterations of the retina in optic coherence tomography (SD-OCT).MethodsThe study design was retrospective with consecutive patient inclusion. In 107 patients with newly diagnosed nAMD, MNV were detected by means of OCTA and automated quantitative vascular analysis was performed. The MNV characteristics measured were area, flow density, total vascular length (sumL), density of vascular nodes (numN), fractal dimension (FD) and average vascular width (avgW). These parameters were assessed for associations with vision (BCVA), central retinal thickness (CRT), fluid distribution, the elevation of any pigment epithelial detachment (PED), the occurrence of subretinal haemorrhage and atrophy.ResultsBCVA was significantly worse with greater MNV area and sumL. Fluid distribution differed significantly in relation to area (p < 0.005), sumL (p < 0.005) and FD (p = 0.001). Greater PED height was significantly associated with higher numN (p < 0.05) and lower avgW (p < 0.05). Atrophy was present significantly more often in MNV with larger area (p < 0.05), higher sumL (p < 0.05) and higher flow density (p = 0.002). None of the MNV parameters had a significant association with CRT or the occurrence of haemorrhage.ConclusionOCTA is not restricted to evaluation of secondary changes but offers the opportunity to analyse the vascular structure of MNV in detail. Differences in vascular morphology are associated with certain secondary changes in retinal morphology. There are thus grounds for optimism that further research may identify and classify OCTA-based markers to permit more individualised treatment of nAMD.
Highlights
Age-related macular degeneration (AMD) is a potentially vision-impairing disease that represents the leading cause of blindness in the industrialised nations
NAMD was first diagnosed by means of fluorescein angiography (FA) and SD-optic coherence tomography (OCT) (SpectralisÓ HRA ? OCT, Heidelberg Engineering, Heidelberg, Germany) together with clinical examination
The FA and SD-OCT images were analysed with regard to central retinal thickness (CRT), fluid distribution, atrophy and pigment epithelial detachment (PED)
Summary
Age-related macular degeneration (AMD) is a potentially vision-impairing disease that represents the leading cause of blindness in the industrialised nations. Indirect stereoscopic ophthalmoscopy permits clinical detection of typical changes affecting the retinal pigment epithelium (RPE), fluid, drusen, haemorrhages, RPE detachment (PED), RPE atrophy or fibrosis, depending on the stage of the AMD. The severity of these changes is extremely heterogeneous both at the time of diagnosis and during the course of the disease, so the treatment required varies widely from case to case, as does the visual impairment. Combined fluorescein angiography (FA) and optic coherence tomography (OCT) is the gold standard for diagnosis of neovascular AMD (nAMD), in which macular neovascularisation (MNV) with subretinal and/or intraretinal exudation occurs. Indocyanine green angiography (ICGA) is often helpful in cases of unclear MNV type
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