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Mirjam EJ Van Velthoven, Jan H. de Jong, Boy Braaf, Maximilian Gräfe, Sankha Amarakoon, Koenraad Arndt Vermeer, suzanne yzer, Tom Missotten, Johannes F De Boer; Monitoring treatment of retinal angiomatous proliferation by phase resolved Doppler OCT. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1615.
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© 2017 Association for Research in Vision and Ophthalmology.
In contrast to most conventional imaging techniques, Doppler OCT is able to provide depth-resolved information about intra- and transretinal blood flow non-invasively. We performed an exploratory prospective, observational cohort study to evaluate Doppler OCT for monitoring the effect of treatment in patients with retinal angiomatous proliferation (type 3 CNV).
Twelve treatment-naïve patients were included, with a median age of 79 years (range 65-90). They were diagnosed with type 3 CNV based on fundus examination, fluorescein angiography and indocyanine-green angiography. Patients were additionally imaged with an experimental 1040 nm swept-source phase resolved Doppler OCT instrument before and after treatment. Patients were treated with either intravitreal bevacizumab or triamcinolone injection(s) with or without photodynamic therapy (PDT). Abnormal blood flow after treatment was defined as unchanged, decreased or absent.
Good quality Doppler OCT images before and after treatment could be obtained in 9 patients. After the first treatment series the type 3 CNV lesion was absent in 7 patients, in 1 patient the Doppler OCT depicted decreased flow in the lesion and 1 patient showed unchanged abnormal blood flow. Only in 1 out of 4 patients complete resolution was seen after a single bevacizumab injection. Combined therapy of bevacizumab with PDT showed complete resolution in 5 out of 5 patients (see figure).
Doppler OCT is able to detect changes in abnormal blood flow after treatment of type 3 CNV. This type of imaging may become an important non-invasive monitoring tool for optimizing treatment strategies in type 3 CNV patients and possibly in other types of macular degeneration.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Doppler en face (left) and tomogram (right) of abnormal intraretinal blood flow continuous to the sub-retinal pigment epithelial (RPE) region at the top of a pigment epithelial detachment (PED). The tomogram position is indicated by a red dotted line in the en face image (left). The Doppler flow information is superimposed in red over the grayscale structural OCT tomogram (right). Top: baseline. Middle: persisting abnormal flow after a single bevacizumab injection. Bottom: Resolution of abnormal flow after additional PDT treatment. The consecutive en face Doppler images (left) show gradual disappearance of the abnormal vascular network.
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