Abstract
We evaluated regression of iris neovascularization (INV) using en-face anterior-segment optical coherence tomography angiography (AS-OCTA) after anti-vascular endothelial growth factor (VEGF) therapy. Seven consecutive eyes with INV were examined before and after anti-VEGF therapy, and all AS-OCTA scans were obtained using a swept-source OCTA system with an anterior-segment lens adapter. Slit-lamp microscopy photography and anterior indocyanine green angiography also were performed. Quantitative analyses of the vascular density, vascular lacunarity, and fractal dimension on AS-OCTA images were performed. AS-OCTA visualized the INV as signals around the pupillary margin, which corresponded to the vasculature confirmed by slit-lamp microscopy. After anti-VEGF drug injection, regression of INV was observed by AS-OCTA in all eyes (100%). The vascular density decreased and vascular lacunarity increased significantly after anti-VEGF therapy. This pilot study demonstrated the ability of AS-OCTA not only to detect but also to evaluate INV. Further study is warranted to improve the algorithm for delineating the iris vasculature to decrease artifacts.
Highlights
Iris neovascularization (INV) and subsequent development of neovascular glaucoma are serious complications for patients with proliferative diabetic retinopathy (PDR), central retinal vein occlusion, and more[1]
We confirmed the presence of iris rubeosis that was detected by slit-lamp microscopy or indocyanine green angiography (ICGA) and corresponded to that seen on the anterior-segment Optical coherence tomography angiography (OCTA) (AS-OCTA) images (Figs 1, 2)
iris neovascularization (INV) was detected by AS-OCTA as signals running around the pupillary margin, which corresponded to the vasculature confirmed by slit-lamp microscopy
Summary
Iris neovascularization (INV) and subsequent development of neovascular glaucoma are serious complications for patients with proliferative diabetic retinopathy (PDR), central retinal vein occlusion, and more[1]. We and other investigators have reported that anti-VEGF therapies such as intravitreal injections of bevacizumab (Avastin, Genentech Inc., South San Francisco, CA, USA), ranibizumab (Lucentis, Genentech, Inc.), and aflibercept (Eylea, Regeneron Pharmaceuticals, Tarrytown, NY, USA) have caused reduction or complete resolution of INV even after only a few days[2,3,4]. Those studies were conducted using only slit-lamp microscopy and angiography. We used anti-VEGF therapies to treat eyes with INV to validate use of SS-based AS-OCTA in the iris and compared the OCTA signals from the INV before and after treatment
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