Occult Choroidal Neovascularization Research Articles

Lack of Response to Intravitreal Ranibizumab Treatment in Adult Onset Foveomacular Vitelliform Dystrophy Complicated with Choroidal Neovascularization: A Case Report

Adult-onset foveomacular vitelliform dystrophy (AOFVD) is a rare disease characterized by accumulation of yellowish deposits in the macula. Rarely, it may be complicated by choroidal neovascularization (CNV). Cases with CNV may be confused with occult CNV in age-related macular degeneration. In our case, we will present the visual and anatomical results of a patient with AOVF-related CNV, in which we administered 3 doses of intravitreal ranibizumab (IVR). A 59-year-old female patient, who attended our clinic with the complaint of decreased vision in both eyes, was diagnosed with AOVF-related CNV in both eyes and was treated with 3 doses of IVR for 3 months. Despite the improvement in visual and anatomical functions 1 month after the first dose, vision decreased, and anatomical functions regressed to the pre-injection state in continued injections. IVR therapy is not an appropriate treatment option in the treatment of AOVF-associated CNV.

Protocol for Indocyanine Green Angiography.

Indocyanine green (ICG) angiography was first approved by the Food and Drug Administration for human use in the 1956. Prior to its use in chorioretinal angiograms, ICG was used to measure blood flow and track cardiac output. It was only in 1969 when two researchers, Kyuga Kogure and Earl Choromokos from the University of Miami, first used ICG to create more accurate angiograms. In the following years, researchers were able to hone the underlying science of this new form of angiography. As time passed and technology advanced, the application of ICG in clinical practice became widespread. Today ICG is used to diagnose and monitor the progression of retinal and choroidal diseases affecting millions of individuals across the globe. ICG utilizes the injection of indocyanine green dye into a patient's bloodstream to visualize abnormalities of the choroid and retina by evaluating choroidal circulation. ICG angiography is useful in the diagnosis and management of occult choroidal neovascularization in age-related macular degeneration and may be used in other inflammatory conditions with central serous chorioretinopathy. ICG angiography offers advanced imaging for improved monitoring and treatment of a wide variety of choroidal and retinal diseases.

Субфовеальная толщина хориоидеи при влажной форме возрастной макулярной дегенерации

Currently, optical coherence tomography in enhanced image depth (EDI-OCT) mode is actively used in the diagnosis and prognosis of treatment of many eye pathologies, including age-related macular degeneration (AMD). Purpose. To assess the subfoveal thickness of the choroid in various types of choroidal neovascularization (CNV) accompanying the wet form of AMD. Material and methods. We examined 24 patients (27 eyes) with wet AMD, who had not previously received treatment. Depending on the type of CNV, the patients were divided into 4 groups: the first group – with occult; the second group – with the classic; the third group – with mixed; the fourth group – with retinal angiomatous proliferation. The control group included 25 people (35 eyes) without eye pathology. All patients underwent standard and specialized ophthalmological examinations. Results. During the morphometric analysis of the subfoveal thickness of the choroid in patients with wet AMD, a significant decrease was recorded relative to the control (p<0.05), except for the group with occult CNV. Conclusion. As a result of the study, changes in choroidal structures are noted with a decrease in the subfoveal thickness of the choroid in wet AMD, as well as in atrophic AMD. Also, when assessing this parameter for different types of CNV, a difference was noted in the eyes with a latent type. Further research is needed to analyze the subfoveal thickness of the choroid in wet AMD, due to the diagnostic and predictive value of this parameter. Key words: age-related macular degeneration, choroidal neovascularization, EDI-OCT, subfoveal thickness of the choroid

Evaluation of Retinal Vessel Density and Foveal Avascular Zone in Unilateral Exudative Choroidal Neovascularization by Optical Coherence Tomography Angiography.

Objectives:To evaluate treatment-naïve patients with neovascular-exudative age-related macular degeneration (eARMD) in one eye and early-/intermediate-stage nonexudative ARMD (neARMD) in the fellow eye by optical coherence tomography-angiography (OCTA).Methods:A total of 70 eyes of 35 patients (17 females) with first diagnosis of eARMD in one eye and early/intermediate-stage neARMD in the fellow eye were included in this study. The eARMD diagnosis was confirmed by fluorescein angiography. Each subject underwent OCTA imaging by RTVue XR Avanti OCT device. Capillary vessel density (VD) of superficial (SCP) and deep (DCP) retinal capillary plexuses and foveal avascular zone (FAZ) parameters were measured.Results:The mean age was 72.0±8.9 years (range 59–87). The mean visual acuity was 0.7±0.5 logMar for the eARMD eyes and 0.4±0.3 logMar for the fellow eyes (p=0.012). Nineteen patients (54.3%) had occult choroidal neovascularization (CNV), and 16 patients (45.7%) had classical CNV. The mean FAZ area was measured 0.30 ± 0.11 mm2 in the eARMD eyes and 0.27±0.11 mm2 in the fellow eyes (p=0.387). The FAZ circularity index measurement was 1.15±0.03 in eARMD eyes and 1.11±0.05 in the fellow eyes (p=0.014). There was no statistically significant difference in any measure of the macular SCP and DCP’s VD between eARMD eyes and their fellow eyes.Conclusion:Potential retinal vascular alterations will be important in ARMD pathogenesis.

Subgroups and Features of Poor Responders to Anti-Vascular Endothelial Growth Factor Treatment in Eyes with Neovascular Age-Related Macular Degeneration

Objectives:This study aimed to determine the incidence of poor response to intravitreal (IV) anti-VEGF treatment in neovascular age-related macular degeneration (nvAMD) and to define subgroups of poor responders.Materials and Methods:A total of 235 treatment-naive eyes of 202 patients completed this prospective study. Patients younger than 50 years of age and those with a contraindication for anti-VEGF therapy were excluded. All eyes were treated with IV ranibizumab. Poor response was defined as recurrence, persistence, or worsening despite treatment. Poor responders were classified into subgroups based on progression patterns.Results:Of the 235 eyes, 78 (33.2%) showed poor response. Pigment epithelial detachment (PED) and occult choroidal neovascularization (CNV) were more common among poor responders (p<0.001) and 5 subgroups were identified.Conclusion:Poor response to anti-VEGF treatment is not uncommon and occult CNV and PED are frequently seen in these eyes. Various subgroups can be defined based on clinical features.

Outcomes by Baseline Choroidal Neovascularization Features in Age-Related Macular Degeneration: A Post Hoc Analysis of the VIEW Studies

To assess the influence of baseline choroidal neovascularization (CNV) features on visual change and fluid resolution after anti-vascular endothelial growth factor (VEGF) treatment of eyes with neovascular age-related macular degeneration (nAMD). Post hoc analysis of 52-week data from the phase 3 Vascular Endothelial Growth Factor VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet Age-Related Macular Degeneration (AMD) Studies (VIEW) 1 and 2 clinical trials. One thousand eight hundred four patients with nAMD. Integrated data from VIEW 1 and 2 of 1804 eyes receiving intravitreal aflibercept injections (IAIs) 2 mg every 4 weeks, IAIs 2 mg every 8 weeks after 3 initial monthly doses, and ranibizumab every 4 weeks with documented baseline CNV type, total area, and leakage area were analyzed. Time to an event and cumulative incidence were evaluated by Kaplan-Meier analysis, and relative risks were estimated using proportional hazards analysis. Cumulative incidence of time to first sustained vision gain of 15 or more Early Treatment Diabetic Retinopathy Study letters, vision loss of more than 5 Early Treatment Diabetic Retinopathy Study letters from baseline, as well as first sustained absence of retinal fluid and intraretinal fluid as evaluated by OCT with respect to CNV type, total CNV, and leakage area. Eyes with predominantly classic CNV (mean best-corrected visual acuity [BCVA], 48.2 letters at baseline) showed a higher incidence rate of first sustained gain of 15 letters or more than eyes with occult CNV (mean BCVA, 57.9 letters at baseline; P < 0.01). Eyes with occult CNV at baseline showed higher incidence rates of first sustained absence of retinal fluid and of intraretinal fluid than eyes with predominantly classic CNV (both P < 0.01). With increasing baseline CNV total area and leakage area, the incidence rate of first sustained gain of 15 letters or more decreased. This post hoc analysis provided additional evidence for the role of baseline CNV features (CNV type, total area, and leakage area) in influencing visual and anatomic outcomes in eyes with nAMD after anti-VEGF treatment.

Agreement of Spectral-Domain OCT with Fluorescein Leakage in Neovascular Age-Related Macular Degeneration: Post Hoc Analysis of the HARBOR Study

To evaluate the agreement between detection of activity of choroidal neovascularization (CNV) in neovascular age-related macular degeneration (AMD) by fundus fluorescein angiography (FFA) and spectral-domain (SD) OCT in the HARBOR study. Most retina specialists rely on OCT to guide treatment decisions in neovascular AMD. However, OCT may not always detect exudative activity. Traditionally, FFA was frequently performed in clinical practice, but its use has diminished due to reliance on OCT. Retrospective post hoc analysis of prospective clinical trial (HARBOR; ClinicalTrials.gov identifier, NCT00891735). Patients with neovascular AMD in the HARBOR Trial. Baseline to month 24 data from all randomized study eyes in HARBOR with both FFA and SD OCT data were analyzed for (1) evidence of CNV activity on SD OCT (presence of subretinal fluid, intraretinal fluid, and/or cystoid spaces); (2) evidence of CNV activity on FFA identified by the presence of leakage, and (3) cross-tabulation of CNV activity identified by FFA and SD OCT by office visit. The percent agreement between FFA and SD OCT in detecting CNV activity and sensitivity and specificity of SD OCT to detect fluorescein leakage in neovascular AMD using FFA as the reference standard. At baseline, 1094 patients (99.9%) had agreement between SD OCT and FFA in detecting CNV activity. By month 24, of the 779 total active cases, the agreement was only 36% (277 cases). By month 24, most cases (n= 452 [58%]) had evidence of CNV activity on SD OCT only, whereas 6% of cases (n= 50) had CNV activity identified by FFA only. At screening and months 3, 6, 12, and 24, 92% to 100% of cases identified by FFA only were occult CNV lesions. Using FFA as the reference standard, the sensitivity and specificity of SD OCT in detecting CNV activity was 91% (95% confidence interval [CI], 84%-99%) and 13% (95% CI, 4%-22%). Spectral-domain OCT alone can be relied upon for detecting CNV activity while monitoring eyes with neovascular AMD. However, FFA may still be of value in those with occult lesions that appear quiescent on SD OCT, as this type of lesion may show leakage on FFA.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY CAN CATEGORIZE DIFFERENT SUBGROUPS OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION.

Choroidal neovascularization (CNV) is a common complication of patients affected by age-related macular degeneration, showing a highly variable visual outcome. The main aim of the study was, at baseline, to perform a quantitative optical coherence tomography angiography assessment of CNV secondary to age-related macular degeneration and to assess posttreatment outcomes. Seventy-eight naïve age-related macular degeneration-related CNV patients (39 men, mean age 78 ± 8 years) were recruited and underwent complete ophthalmologic evaluation and multimodal imaging. Several OCT and optical coherence tomography angiography parameters were collected, including vessel tortuosity and vessel dispersion (VDisp), measured for each segmented CNV. All patients underwent anti-vascular endothelial growth factor PRN treatment. Vessel tortuosity and VDisp values of CNVs were tested at baseline to establish a cutoff able to distinguish clinically different patient subgroups. Mean best-corrected visual acuity was 0.49 ± 0.57 (20/62) at baseline, improving to 0.31 ± 0.29 (20/41) at the 1-year follow-up (P < 0.01), with a mean number of 6.4 ± 1.9 injections. Our cohort included the following CNV types: occult (45 eyes; 58%), classic (14 eyes; 18%), and mixed (19 eyes; 24%). Observing optical coherence tomography angiography parameters, classic, mixed, and occult CNV revealed significantly different values of VDisp, with classic forms showing the highest values and the occult CNVs showing the lowest (P < 0.01); mixed forms displayed intermediate VDisp values. The ROC analysis revealed that a CNV vessel tortuosity cut-off of 8.40, calculated at baseline, enabled two patient subgroups differing significantly in visual outcomes after anti-vascular endothelial growth factor treatment to be distinguished. A baseline quantitative optical coherence tomography angiography-based parameter could provide information regarding both clinical and functional outcomes after anti-vascular endothelial growth factor treatment in age-related macular degeneration-related CNV.

Association of Longitudinal Changes in Drusen Characteristics and Retinal Layer Volumes with Subsequent Subtype of Choroidal Neovascularisation

Aim: To investigate the longitudinal correlation between drusen characteristics and retinal layer volumes pre conversion and subsequent type of choroidal neovascularisation (CNV). Methods: This was a single-centre retrospective study. The study participants were patients with wet age-related macular degeneration (AMD) in one eye who developed wet AMD in the contralateral eye, with at least 2 years of follow-up prior to conversion. The Moorfields Eye Hospital database was searched for eligible patients and their data were recorded. Eyes were classified as occult or classic based on fundus fluorescein angiography. Optical coherence tomography (OCT) images were analysed for drusen characteristics and retinal layer volumes were analysed over time using automated software (Topcon 3D OCT-2000 and Orion, Voxeleron LLC, respectively). All values were obtained at baseline as well as year 1 and year 2 before conversion to wet AMD. Results: Fifty-one eyes with bilateral CNV showed high correlation of type of CNV between eyes (kappa statistic 0.89). A total of 49 wet AMD eyes (29 occult, 20 classic) were analysed for drusen parameters. Two patients with retinal angiomatous proliferation were excluded. Drusen count, area, and volume did not differ by CNV type, but the rates of change of drusen area (p = 0.046) and drusen volume (0.022) were higher in the occult group in the year preceding CNV development. Of the 49 eyes, 17 (10 occult, 7 classic) with available good quality OCT were analysed for retinal layer volumes. There was a progressive reduction in outer nuclear layer (ONL) volume (p = 0.002) and an expansion in outer plexiform layer volume (p = 0.015) in eyes that developed occult CNV. Conclusion: Our study shows that rate of increase in drusen load and reduction in ONL are significant features seen in eyes developing occult CNV, highlighting new imaging markers that need to be replicated in larger studies. These markers provide insight into the pathogenesis of CNV and may serve as prognostic indicators, as classic CNV carries a poorer prognosis compared to occult CNV.

Features and Diagnostic Accuracy of Optical Coherence Tomography Angiography in Neovascular Age-related Macular Degeneration.

IntroductionAge-related macular degeneration (AMD) is one of the important causes of visual impairment in aging population. Fundus fluorescein angiography (FFA) is gold standard for the diagnosis of neovascular AMD (nAMD) while optical coherence tomography (OCT) aids in the diagnosis of nAMD and is very useful for follow-up. OCT angiography (OCTA) is an evolving imaging technology that can be used as a valid diagnostic tool to study morphology of choroidal neovascularization (CNV) that is seen in nAMD. This study was conducted with the objective to determine diagnostic accuracy and OCTA features of occult and classic CNV in patients with nAMD.MethodsIn this prospective observational study, 90 eyes of 58 patients with nAMD were studied with OCT, OCTA and FFA. OCTA scans were analyzed to qualitatively describe the morphological appearance of CNV in terms of location, pattern and configuration. The OCTA sensitivity and specificity for CNV detection were calculated by comparing it with FFA.ResultsFFA detected CNV in 70 of the 90 eyes (77.77%) whereas OCTA identified CNV in 69 eyes (76.7%). Among 69 eyes with CNV, it was well-defined in 51 (73.9%) eyes and poorly defined in 18 (26.1%) eyes. There were four false positive and five false negative cases. The sensitivity, specificity, positive predictive value and negative predictive value of OCTA in detection of nAMD were found to be 92.85%, 80.0%, 94.2 and 76.2, respectively.ConclusionOCTA is a useful, noninvasive, reproducible imaging tool for diagnosing, classifying and localizing CNV. The technique has high sensitivity and specificity and can be used reliably in cases where FFA is contraindicated or inconclusive.

Clinical characteristics of cuticular drusen in the Japanese population.

To investigate the clinical characteristics of eyes with cuticular drusen in Japanese individuals, while paying special attention to large colloid drusen (LCD). Retrospective case series. Eyes with cuticular drusen, from patients of 4 medical institutes in Japan, were investigated. Multimodal imaging findings were used to diagnose cuticular drusen. LCD was defined as cuticular drusen > 200µm. Twenty-four eyes from 12 patients (8 women, 4 men) were diagnosed with cuticular drusen. The mean age of all patients (n = 12) was 60.8years. The mean age of patients without additional macular pathology (n = 5) was 55.4years. Of the 7 patients with additional macular pathology, 6 (85.7%) exhibited age-related macular degeneration-associated macular pathology, including drusenoid pigment epithelial detachment (PED) (8 eyes from 4 patients), geographic atrophy (2 eyes from 1 patient), and occult choroidal neovascularization (1 eye). LCD were found in 6 eyes of 3 patients (25%), those with LCD were on average 53.7 ± 8.7years old and those without 69.9 ± 14.1years of age (P = 0.064, Mann-Whitney U test). Cuticular drusen were predominantly seen in females, and drusenoid PED was most frequently seen in eyes with additional macular pathology. LCD were seen in 25% of eyes with cuticular drusen.

Resident Perspectives

Resident Perspectives

Choroidal Neovascularisation Complicating Chronic Central Serous Chorioretinopathy: The Discovery Rate on Multimodal Imaging.

To identify the image modality allowing identification of choroidal neovascularisation (CNV) complicating chronic central serous chorioretinopathy (CSCR), including fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCT-A). Patients diagnosed with chronic CSCR and secondary CNV were included in the study. The image modalities FA, ICGA, and OCT-A were reviewed for specific CNV signs permitting diagnosis. Patients with missing image modalities, poor image quality, previous laser treatment, or other confounding pathologies were excluded. CNV was identified on OCT-A in 32 of 33 eyes (97%), whereas ICGA revealed an abnormal vascular network in 23 eyes (70%), significantly less frequently than with OCT-A (p = 0.003). FA allowed CNV identification in 10 eyes (30%), significantly less frequently than with OCT-A (p < 0.001). Type 1 CNV was detected by OCT-A in 29 of 30 eyes (97%), by ICGA in 20 eyes (67%; p = 0.0027), and by FA in 8 eyes (27%; p < 0.001). OCTA is a useful diagnostic tool to detect occult CNV complicating chronic CSCR. This image modality might be important for adequate patient care.

Five-Year Real-World Outcomes of Occult and Classic Choroidal Neovascularization: Data From the Fight Retinal Blindness! Project

To compare 5-year real-world outcomes of eyes with classic and occult choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (anti-VEGF) injections. Retrospective analysis from a prospectively designed observational database. Treatment-naïve eyes diagnosed with occult or minimally or predominantly classic CNV that commenced anti-VEGF treatment between January 2007 and December 2012 were identified from a registry of neovascular age-related macular degeneration (nAMD) treatment outcomes. Baseline characteristics, visual acuity (VA) at 5 years, change in VA, time to first inactivation, number of injections, and proportion of visits graded with active nAMD over the 5 years were compared between the 3 groups. A total of 1929 eyes from 1730 subjects (1196 occult, 289minimally classic, and 444 predominantly classic CNV) were analyzed. Baseline VA (mean [standard deviation]) was higher in occult CNVs (56.9 [17.4] letters) than in minimally (52.9 [19.7] letters) and predominantly (49.1 [19.9] letters) classic CNVs (P= .003 and P < .0001, respectively). VA change was similar across the groups. At 5 years eyes with occult CNVs still had better VA than other CNVs. Age, lesion size, and baseline VA, but not CNV type, significantly affected final VA in the multivariate model. Predominantly classic CNVs became inactive sooner and were overall less active than other CNV types. The number of injections received was similar across the groups. Eyes with occult CNVs had overall a better VA than other CNVs. The difference in final VA was not significant after adjusting for baseline VA. Five-year outcomes and treatment patterns were not affected by the lesion type.

EVEREST study report 4: Fluorescein angiography features predictive of polypoidal choroidal vasculopathy.

ImportanceIt is important to identify features of polypoidal choroidal vasculopathy (PCV) that differentiate it from typical neovascular age‐related macular degeneration (nAMD) on various imaging modalities, including fluorescein angiography (FA).BackgroundPCV was thought to be indistinguishable from nAMD using FA alone. In real‐world practice, indocyanine‐green angiography may often be unavailable or contraindicated.DesignAnalysis of FA images from a prospective, multicentre study.ParticipantsStudy images of both PCV and nAMD patients from the EVEREST study.MethodsFA features at baseline were independently graded by masked graders (fellowship‐trained ophthalmologists) using standardized diagnostic algorithms.Main Outcome MeasuresPredictive indicators (sensitivity, specificity, positive and negative predictive values) for PCV.ResultsOf the 95 patients screened, 61 had PCV. Of the 34 screening failures, 15 were diagnosed as nAMD. Hyperfluorescent nodules on FA were observed in 80% of patients with PCV vs 20% with nAMD (P < 0.001). Blocked fluorescence on FA, which corresponded to the presence of subretinal haemorrhage, occurred more frequently among patients with PCV vs nAMD (61.7% vs 13.3%, P = 0.001). Similarly, the leakage characteristic of occult choroidal neovascularization occurred more frequently among patients with PCV vs nAMD (95.0% vs 73.3%, P = 0.026). The positive predictive value for PCV was 94.1% for hyperfluorescent nodules, 94.9% for blocked fluorescence, 83.8% for occult choroidal neovascularization and 82.0% for pigment epithelial detachment.Conclusions and RelevanceThis study demonstrated that certain FA features can be predictive of PCV and may be considered as an indication for retina specialists to perform indocyanine green angiography as confirmatory test.

Assessment of Wet Age-Related Macular degeneration by Optical Coherence Tomography Angiography

Background: to date, fundus fluorescein angiography (FFA), remains the gold standard for the diagnosis of choroidal neovascular membrane (CNV). Optical coherence tomography angiography (OCTA) is a new imaging modality that allows a clear, depth-resolved visualization of the retinal vascular structures. Aim of the Work: to evaluate the role of OCTA in diagnosis of CNV in patients with age-related macular degeneration (AMD). Patients and Methods: this study enrolled 32 patients (40 eyes), including 20 patients (20 eyes) with wet AMD and 12 patients (20 eyes) with dry AMD. All patients underwent swept-source optical coherence tomography (SS-OCT), swept-source OCTA, and fundus fluorescein angiography (FFA). OCTA was used to evaluate neovascular networks in terms of their type, location and extent of visualization. Sensitivity and specificity of the method were assessed separately in a group of 20 CNV eyes and 20 dry AMD based on FFA diagnosis as the gold standard. Results: sensitivity and specificity of en face OCTA were 95% and 100% respectively. Both Sensitivity and specificity of structural OCT were 100%. Conclusion: OCTA enables diagnosis of both classic and occult choroidal neovascularization in patients with AMD. The method has high sensitivity and specificity.

Topographic Correspondence of Macular Atrophy With Choroidal Neovascularization in Ranibizumab-treated Eyes of the TREX-AMD Trial

To quantify the extent of topographic correspondence between baseline (BSL) choroidal neovascularization (CNV) and macular atrophy (MA) at follow-up in eyes with neovascular age-related macular degeneration (NVAMD). Post hoc analysis of randomized controlled clinical trial data. Sixty treatment-naïve NVAMD patients from the TREX-AMD trial were followed for 18months. Regions of month 18 macular atrophy (MA) were graded on fundus autofluorescence (FAF) with guidance of spectral-domain optical coherence tomography (SDOCT). CNV lesions were graded manually on fluorescein angiography (FA) with lesion components including classic and occult CNV delineated. FAF and FA images were registered to quantitate area and location of overlap between CNV and MA. Outcome measures included overlap of month 18 MA to BSL CNV subtype and progression of MA from BSL to month 18. Twenty-six eyes had both MA at month 18 and CNV at BSL. A total of 84.6% of eyes showed evidence of MA and CNV overlap. MA appeared by month 18 in regions corresponding to BSL classic CNV in 36.4% of eyes and occult CNV in 40.9%, and in both regions in 22.7%, with more area of MA (AMA) in regions of occult than classic CNV. MA position at BSL corresponded to BSL classic CNV in 76.9% of eyes and occult CNV in 61.5%, and to both regions in 15.4%, with more AMA in regions of occult than classic CNV. Among eyes with MA and CNV at BSL but with no overlap, 50% progressed to involve regions with BS -CNV. Six eyes had no BSL MA but developed MA at month 18 within regions of BSL CNV. In ranibizumab-treated eyes with NVAMD, more MA lesions develop within the region of baseline CNV (type 1, CNV-based MA) than outside (type 2, CNV-independent MA). Baseline-MA also tends to be located within regions of CNV in the pretreatment phase.

Interpretation of Subretinal Fluid Using OCT in Intermediate Age-Related Macular Degeneration

To determine the natural history of asymptomatic, subretinal fluid (SRF) in intermediate age-related macular degeneration (iAMD) and highlight the entity of nonexudative detachment of the neurosensory retina (NEDNR). Prospective, observational case series. Cases of iAMD with bilateral drusen >125 μm who were participating in a longitudinal study, in whom spectral-domain (SD)-OCT imaging detected asymptomatic SRF. Participants underwent clinical examinations every 6 months with multimodal imaging that included infrared reflectance, fundus autofluorescence, and SD-OCT. The grading center identified eyes with SRF. Eyes with SRF ≤30 μm were monitored more regularly, whereas eyes with SRF >30 μm underwent fluorescein angiography (FA) and indocyanine green angiography (ICGA). Subretinal fluid without evidence of neovascularization or polyp was termed "NEDNR". All cases of SRF underwent swept-source OCT angiography (SS-OCTA) to determine if choroidal neovascularization (CNV) was present and were then followed prospectively. Natural history of iAMD eyes with SRF that had no evidence of neovascularization during the monitoring period of 30 to 54 months. Sixteen eyes of 12 patients with iAMD developed asymptomatic SRF over a follow-up period of 30 to 54 months. Four eyes developed occult CNV on FA and were no longer followed in this study. Four eyes developed SRF ≤30 μm, and 8 eyes developed SRF >30 μm, with 11 of the 12 eyes developing subretinal hyperreflective material (SHRM). None of these 12 eyes showed any evidence of neovascularization at the initial detection of SRF and were termed "NEDNR". During the follow-up period of 12 to 36 months after the onset of SRF, only 1 eye developed exudative CNV. The remaining 11 eyes failed to demonstrate any abnormal choroidal vasculature on SS-OCTA, including 4 eyes with cuticular drusen in which SHRM developed into a large subfoveal vitelliform-like deposit. Multimodal imaging is helpful for the interpretation and management of asymptomatic SRF in iAMD. In some eyes, all imaging, including SS-OCTA, failed to demonstrate subclinical neovascularization, and we use the acronym NEDNR to describe these cases. This phenotype within iAMD needs to be recognized and monitored to determine if and when treatment might be needed.

Intravitreal triamcinolone in the treatment of serous pigment epithelial detachment and occult choroidal neovascularization secondary to age-related macular degeneration.

To report two cases of occult choroidal neovascularization (CNV) and serous pigment epithelial detachment (PED) treated with intravitreal triamcinolone (IVT) injections. Interventional case reports. Both patients showed an increase in visual acuity and a complete flattening of the PED at 10 months (Case 1) and 4 months (Case 2) after IVT injections. No complications or adverse effects are reported. Future studies should be designed to investigate if IVT can effectively influence the clinical and functional outcome of eyes with serous PED and occult CNV secondary to age-related macular degeneration, for which at the moment no treatment has been shown to be effective.

Optical coherence tomography and angiography in patients with angioid streaks.

To investigate the retinal and choroidal features of angioid streak by fluorescein angiography (FA), indocyanine green anigography (ICG-A) and optical coherence tomography (OCT). We analysed 46 eyes of 23 patients with angioid streaks examined at our retina section between March 1998 and June 2000. Their mean age was 42.8 years (26-61 years). After a routine ophthalmological examination, OCT and simultaneous fluorescein and indocyanine green angiography (FA/ICG-A) were done. Color fundus photographs were also taken. A peau dorange appearance and angioid streaks were more numerous and apparent with ICG-A than FA. In two eyes (4.3%), some streaks that were well visualized on FA were not visible on ICG-A. Twenty eyes (43.5%) had macular complications and 26 (56.5%) were normal. Occult choroidal neovascularization (CNV) was diagnosed by ICG-A. Nine eyes had occult, and 11 had classic CNV. Ruptures of Bruchs membrane were hypofluorescent in 20 (43.5%) and hyperfluorescent in 26 eyes (56.5%). Optic disc drusen were detected in both eyes of one patient (4.3%). Localized hyperreflectivity was thought to be due to calcium deposits. Angioid streaks were visualized more clearly and in larger numbers by ICG-A than FA. However, in some cases streaks that were funduscopically and fluorescein angiogrpahically visible could not be seen by ICG-A. Occult CNV was detected by ICG-A. Some mottled areas were seen and more clearly visualized by ICG-A. Calcium deposits were observed as localized areas of hyperreflectivity on OCT. These findings indicate that fluorescein angiography, ICG-A and optical coherence tomography all provide supportive information for each other and can be used for either diagnosis or follow-up of those patients. (Eur J Ophthalmol 2002; 12: 473-81).