Spectral-domain optical coherence tomography imaging of the retinal pigment epithelium in myopic choroidal neovascularization

Abstract

Purpose: To analyze the retinal pigment epithelium (RPE) appearance of inactive myopic choroidal neovascularization (CNV) with spectral-domain optical coherence tomography (SD-OCT) and to evaluate its association with the lesion size and the treatment duration.

Methods: We retrospective reviewed imaging studies of eyes with inactive myopic CNV after successful treatment. Imaging included infrared reflectance (IR), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography, and spectral-domain optical coherence tomography (SD-OCT). Patients were divided into two groups. Group 1 showed uniformity of the RPE (defined as continuous and highly reflective layer on SD-OCT) over the CNV, while group 2 showed an irregular RPE (defined as disrupted and poorly reflective layer on SD-OCT). The presence of perilesional hyper-reflective ring (PHR) in IR imaging was determined; the major diameter (MajD), the minor diameter (MinD) and the area of the lesion (A2) in early FA images were measured using the built-in caliper of the SD-OCT device. The number of treatments performed before CNV stabilization was assessed for every patient.

Results: Eighty-one eyes of 72 patients were included. Group 1 and group 2 included 27 and 54 eyes, respectively. MajD, MinD and A2 of the CNVs were significantly lower in group 1 than in group 2 (p<0.001). Group 2 patients needed greater number of treatments than group 1 patients (p<0.01). The presence of a PHR was detected more frequently in group 1 than in group 2 (p<0.01). Binary regression analysis showed that the only predictor for the presence of a uniform RPE after successful treatment was the size of the CNV. Conditional selection of variables showed that the best regression model for the presence of a regular RPE after successful treatment included size of the lesion and presence of the PHR.

Conclusions: The uniformity of RPE and the presence of PHR turned out to be good prognostic factors for myopic CNVs. Size of myopic CNV influences the development of a uniform RPE over the lesion and, consequently, can condition the prognosis of the disease.

Keywords: 605 myopia • 453 choroid: neovascularization • 701 retinal pigment epithelium