Abstract
Optical coherence tomography angiography (OCTA) is a novel, non-invasive imaging tool used to detect vascular flow. The absence of a flow signal in OCTA in polyps revealed by indocyanine green angiography (ICGA) in patients with polypoidal choroidal vasculopathy (PCV) may indicate slow or compromised filling of blood flow from choroidal vessels. Naïve patients with PCV treated with intravitreal injections of aflibercept (IVI-A) were enrolled in this study to validate the hypothesis that baseline flow may affect the outcome of polyp regression in ICGA. The flow signal of polyps in OCTA was detected by manual segmentation in the corresponding location by ICGA. Polyps were defined as high-flow if both OCTA and ICGA showed positive findings, and low-flow if OCTA showed a negative flow signal in 3 consecutive horizontal scans at the polyp area shown in ICGA. A total of 24 polyps were identified in 13 PCV patients at baseline. Of these 24 polyps, 22 (91.7%) were high-flow and 2 (8.3%) were low-flow. After 3 monthly IVI-A, all low-flow polyps had complete regression in ICGA. Among 17 (77%) high-flow polyps at baseline that had regression after treatment, 10 (58.8%) became low-flow, while 5 (22.7%) persistent polyps remained high-flow. Flow signal of polyps as detected by OCTA could be a predictive factor for treatment response in patients with PCV. Monitoring changes in flow signal after treatment is clinically relevant.
Highlights
Optical coherence tomography angiography (OCTA) is a new and non-invasive imaging tool used to detect vascular flow by computing signal decorrelation from moving blood in vessels between consecutive cross-sectional scans
Applying OCTA in addition to fundus color imaging, fluorescein angiography and structural OCT has been shown to increase the sensitivity but not the specificity of diagnosing polypoidal choroidal vasculopathy (PCV) [11]. This may be due to the over diagnosis of occult choroidal neovascularization (CNV) as PCV caused by the low polyp detection rate of OCTA
Our results showed that the presence or absence of a flow signal in the polyps in OCTA may have been associated with different treatment responses after intravitreal anti-VEGF injections
Summary
Optical coherence tomography angiography (OCTA) is a new and non-invasive imaging tool used to detect vascular flow by computing signal decorrelation from moving blood in vessels between consecutive cross-sectional scans. Compared to the gold standard of indocyanine green angiography (ICGA) [1], OCTA has a greater branching vascular network (BVN) detection rate of 80~100% but lower polyp detection rate of 45~85% [2,3,4,5,6,7,8,9,10]. Applying OCTA in addition to fundus color imaging, fluorescein angiography and structural OCT has been shown to increase the sensitivity but not the specificity of diagnosing polypoidal choroidal vasculopathy (PCV) [11]. This may be due to the over diagnosis of occult choroidal neovascularization (CNV) as PCV caused by the low polyp detection rate of OCTA.
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