OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY CHANGES IN MYOPIC CHOROIDAL NEOVASCULARIZATION BEFORE AND AFTER INTRAVITREAL RANIBIZUMAB INJECTION

Abstract

Background: Progressive and excessive elongation of the globe may lead to many complication one of them is myopic choroidal neovascularization which can be diagnosed with FFA, OCT and OCTA and treated with intravitreal injection of Ranibizumab. Objective: To investigate morphological changes in myopic choroidal neovascularization (mCNV) using optical coherence tomography-angiography (OCT-A) after treatment with ranibizumab. Patients and methods: This study is prospective cross sectional interventional study on 50 high myopic eyes with naive mCNV. All patients were imaged at baseline with color pictures, FFA, OCT and OCT-A at baseline and after treatment. Results: There was a significant improvement of best corrected visual acuity and decrease in central foveal thickness after intravitreal injection of Ranibizumab. Optical coherence tomography angiography can detect myopic choroidal neovascularization with high sensitivity with different patterns (sea-fan, medusa and tree-in-bud) but after treatment this abnormal vascularization may not be detected in some cases and lower number of injection needed in tree-in-bud pattern. Conclusion: OCTA can be used in diagnosis of mCNV with high sensitivity (88 %) with three patterns tree-in-bud, medusa and sea-fan with tree-in-bud represents the most common pattern of mCNV. Ranibizumab intravitreal injection is an effective treatment in mCNV using 1+PRN protocol with significant improvement of BCVA and decrease in CFT. Unlike CNV due to AMD mCNV may regress with single or double injection with improvement of BCVA and larger number of injection is usually needed in older age patients and with mature patterns (medusa and sea-fan) of mCNV.