Swept-Source Optical Coherence Tomography Angiography According to the Type of Choroidal Neovascularization.

Jee Taek Kim,Hum Chung,Joon Hyung Yeo

doi:10.3390/jcm8091272

Abstract

We analyzed and compared the sensitivity of choroidal neovascularization (CNV) detection according to CNV type in patients with active neovascular age-related macular degeneration (AMD) using swept-source optical coherence tomography (OCT) angiography (OCTA). A retrospective chart review was performed in patients with neovascular AMD. OCTA images were classified into three groups: Group A (well-circumscribed vascular complex); Group B (moderately circumscribed vascular complex); and Group C (poorly circumscribed vascular complex), according to CNV appearance. Demographic characteristics, OCT parameters, neovascularization subtypes, and OCTA image quality were analyzed to determine the effect on visualization of the neovascular complex. A total of 130 patients with CNV secondary to active neovascular AMD were analyzed. Among them, 52 eyes from 47 patients were included in the study. Eighteen eyes (34.6%) were classified into Group A, 24 (46.2%) into Group B, and 10 (19.2%) into Group C. Statistical analysis showed no significant differences in demographic characteristics or OCT parameters between the three groups. Overall sensitivity of active CNV detection was 80.7% (42/52 eyes). In 73.5% (25/34) of eyes with type 1 CNV (sub-retinal pigment epithelial type), 100.0% (9/9) of eyes with type 2 CNV (sub-retinal type), and 88.9% (8/9) of eyes with type 3 CNV (retinal angiomatous proliferation type), the vascular complex was well visualized on OCTA. OCTA provides adequate noninvasive imaging of CNV in patients with neovascular AMD, which may assist in CNV diagnosis and activity monitoring. In particular, type 2 CNV was well detected in OCTA in comparison with type 1 and type 3 CNV.

Highlights

Neovascular age-related macular degeneration (AMD), characterized by choroidal neovascularization (CNV), is a leading cause of vision impairment in developed countries
The purpose of this study was to assess and compare the sensitivity of swept-source OCT angiography (OCTA) (SS-OCTA) to visualize CNV lesions according to CNV type and analyze the factors that affect visualization of CNV in patients with active neovascular AMD
A retrospective chart review was performed in patients with neovascular AMD and clinical data were collected including patient demographics, best-corrected visual acuity, intraocular pressure, refractive errors, and history of intravitreal anti-vascular endothelial growth factor (VEGF) treatment

Summary

Introduction

Neovascular age-related macular degeneration (AMD), characterized by choroidal neovascularization (CNV), is a leading cause of vision impairment in developed countries. Severe visual loss of AMD may occur due to CNV and its consequences: exudation, bleeding, and disciform scar [1]. Fluorescein angiography (FA) has been used as the gold standard to visualize CNV in the retina [2,3]. Indocyanine green angiography (ICGA) has been used to detect polypoidal lesions in the choroid [4]. These angiography examinations show considerable sensitivity and specificity for the detection of CNV or polyp. A recently developed confocal type of angiography (Heidelberg Retina Angiograph 2, Heidelberg Engineering, Heidelberg, Germany) showed detailed vascular abnormalities in the macula. FA and ICGA, which both use intravenous dye injection, are inevitably associated with several adverse effects, ranging from mild nausea and rash to serious anaphylactic shock

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