Abstract
Purpose To evaluate the capability of swept source-optical coherence tomography angiography (SS-OCTA) in the detection and localization of treatment-naive macular neovascularization (MNV) secondary to exudative neovascular age-related macular degeneration (nAMD). Methods In this prospective, observational case series, 158 eyes of 142 patients were diagnosed with exudative nAMD using fluorescein (FA) and indocyanine green angiography (ICGA) and evaluated by SS-OCTA in a tertiary retina center (Rudolf Foundation Hospital Vienna, Austria). The main outcome measure was the sensitivity of SS-OCTA compared to the standard multimodal imaging approach. Secondary outcome measure was the anatomic analysis of MNV in relation to the retinal pigment epithelium. Results En-face SS-OCTA confirmed a MNV in 126 eyes (sensitivity: 79.8%), leaving 32 eyes (20.2%) undetected. In 23 of these 32 eyes (71.9%), abnormal flow in cross-sectional SS-OCTA B-scans was identified, giving an overall SS-OCTA sensitivity of 94.3%. Eyes with a pigment epithelium detachment (PED) ≥ 300 μm had a smaller probability for correct MNV detection (p=0.015). Type 1 MNV showed a trend (p=0.051) towards smaller probability for the correct detection compared to all other subtypes. Other relevant factors for the nondetection of MNV in SS-OCTA were image artifacts present in 3 of 32 eyes (9.4%). SS-OCTA confirmed the anatomic localization of 93 in 126 MNVs as compared to FA (sensitivity: 73.8%). There was no influence of age, gender, pseudophakia, visual acuity, central foveal thickness, or subfoveal choroidal thickness on the detection rate of MNV. Conclusions SS-OCTA remains inferior to dye-based angiography in the detection rate of exudative nAMD consistent with type 1 MNV and a PED ≥300 µm. The capability to combine imaging modalities and distinguish the respective MNV subtype improves its diagnostic value.
Highlights
Dilated fundus examination and multimodal imaging including optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) are currently utilized to diagnose neovascular agerelated macular degeneration [1,2,3]
The best observed cut-off was determined at 279 μm. ere was no influence of age, gender, pseudophakia, Best corrected visual acuity (BCVA), central foveal thickness (CFT), or Subfoveal choroidal thickness (SFCT) on the detection rate of macular neovascularization (MNV)
We investigated the capability of the noninvasive SS-OCT angiography (OCTA) technique for the detection and localization of treatment-naive exudative neovascular agerelated macular degeneration (nAMD) in a representative number of 158 eyes
Summary
Dilated fundus examination and multimodal imaging including optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) are currently utilized to diagnose neovascular agerelated macular degeneration (nAMD) [1,2,3]. Type 1 and type 2 MNV originate from the choroid, while type 3, formerly described as retinal angiomatous proliferation, reflects a distinct form of nAMD with intraretinal neovascularization and possible involvement of the choroid [6, 7]. OCT angiography (OCTA) has emerged as a fast and noninvasive imaging technique to evaluate retinal pathologies [10, 11]. E recent implementation of OCTA in clinical routine enabled new possibilities for the detection, analyzation, and observation of MNV in AMD [14,15,16]. Commercially available for a few years, swept source-OCTA (SS-OCTA) is the most promising OCTA technology with a longer wavelength and greater signal-to-noise ratio at greater imaging depths, resulting in deeper tissue penetration, better visualization of microvascular structures, and higher diagnostic accuracy compared to spectral domain-OCTA (SD-OCTA) [17,18,19,20,21]
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