Retinal pigmental epithelium elevation and external limiting membrane interruption in myopic choroidal neovascularization: correlation with activity.

Abstract

To describe the morphological changes in myopic choroidal neovascularization (mCNV) on spectrum domain optical coherence tomography (SD-OCT) and to find a new strategy to evaluate their activity. Characteristics of SD-OCT and fundus fluorescein angiography (FFA) before and after ranibizumab treatment of 52 eyes with active mCNV were analyzed. SD-OCT parameters associated with mCNV activity and the clinical significance of their sensitivity and specificity were analyzed using FFA as a standard reference. Retinal pigment epithelium (RPE) elevation was noted as highly correlated to the mCNV activity. Intraobserver agreement was substantial for all OCT parameters. However, interobserver agreement was low for intraretinal fluid (IRF). To evaluate the CNV activity, sensitivity of presence of subretinal fluid (SRF) and interruption of ellipsoid zone (EZ) was 23.9 and 82.1%, and specificity was 97.5 and 19.8%. External limiting membrane (ELM) interruption showed high sensitivity (97.0%) but low specificity (55.6%) due to the development of RPE elevation. A novel two-step procedure using ELM interruption and RPE elevation was developed to evaluate mCNV activity with sensitivity 92.5% and specificity 95.1%, respectively. Final agreement was as high as 93.9%, with a kappa value of 0.877 (P < 0.001). A novel two-step diagnostic procedure combining ELM interruption with RPE elevation is considered a valuable guide for diagnosis and monitoring of mCNV.