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Sarwar Zahid, KaPo Yeung, Kevin Chen, Richard T Atallah, Daniel Simhaee, Joseph Tseng, Kenneth Wald; Imaging Studies for the Management of Choroidal Neovascularization in Patients with Myopic Degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5902.
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© ARVO (1962-2015); The Authors (2016-present)
To determine if optical coherence tomography (OCT) is a reliable method of detecting disease activity and therefore making management decisions in eyes with choroidal neovascularization (CNV) from Myopic Macular Degeneration (MMD). Fluorescein Angiography (FA) is considered the gold standard for detection of CNV from all causes. Long-term, ongoing management of patients with CNV most typically relies on OCT because it is rapid, inexpensive and noninvasive. Evidence of fluid on OCT imaging is considered a proxy for disease activity in eyes with Age-Related Macular Degeneration (ARMD), but its reliability is uncertain in MMD.
A retrospective study was conducted of 18 patients with CNV related to MMD. Clinical data collected include history, visual acuity, fundus examination, OCT and FA (on initial and some follow-up visits). MMD was defined as eyes that on examination exhibited posterior staphyloma, retinal pigment epithelial attenuation, obliquely inserted optic nerves, RPE atrophy, breaks in Bruch’s membrane (lacquer cracks), and choroidal thinning on OCT. CNV was defined as progressive hyperfluorescence on FA.
Average age at presentation was 60.7 years (range: 36 to 84). All patients had visual symptoms at presentation. In 12 of 18 patients, FA was able to detect CNV without OCT evidence of exudation. All eyes received anti-VEGF therapy (average 2.3 doses). Subsequent follow-up included 38 FA studies (in 15 patients) performed when symptoms recurred. Of those 38, 26 (68.4%) exhibited angiographic leakage, while only 12 (31.6%) had evidence of fluid on OCT.
Patients with myopic degeneration suspected of having active CNV (initially or on follow-up visits) should undergo FA if symptoms suggest recurrent disease. Management based on OCT evidence of disease activity may result in delay in diagnosis and/or treatment. OCT appears to have a lower sensitivity in detecting disease activity in eyes with MMD than in eyes with ARMD.
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