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Eleonora M. Lad, Lili Grunwald, Priyatham S. Mettu, Neha P. Serrano, Sara Crowell, Scott W. Cousins; Lesion Morphology on Indocyanine Green Angiography in Age-Related Macular Degeneration with Classic Choroidal Neovascular Membrane: Implications for Response to anti-VEGF Treatment. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5161.
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To evaluate whether vascular morphology of neovascular lesions on indocyanine green angiography (ICGA) in eyes with AMD and classic choroidal neovascular membrane (CNV) on fluorescein angiography (FA) predict response to anti-vascular endothelial growth factor (VEGF) therapy.
Retrospective study of eyes with neovascular AMD and classic CNV on FA that have undergone high-speed video ICGA and intravitreal anti-VEGF induction therapy (defined as 3-5 injections over 6 months). Cases were identified using a DEDUCE (Duke Enterprise Data Unified Content Explorer) search performed from August 1, 2005 to December 15, 2010. Disease activity was assessed by fundus examination, optical coherence tomography (OCT) and FA before and after induction therapy.
33 eyes of 33 patients with neovascular AMD and classic CNV that had ICGA and underwent anti-VEGF induction therapy were identified using the DEDUCE search and subsequent review of the medical records. The most common type of vascular morphology on ICGA at presentation was capillary (36%), followed by mixed lesion (23%). Complete lesion regression was noted in 24% of the eyes on FA and OCT. Of the cases with complete regression, 86% were found to have the capillary subtype on ICGA.The mixed and arteriolized vascular complex (AVC) subtype were most likely to be associated with persistent disease activity following anti-VEGF induction therapy. Persistent activity was defined as lack of resolution of intraretinal fluid or subretinal fluid on OCT, leakage on FA or presence of new hemorrhage. Among the cases with persistent disease activity, the most common lesion types on presentation were mixed (33%) and capillary (21%), followed by AVC (13%) and retinal angiomatous proliferation (RAP) (13%). The most common vascular morphology in patients with persistent activity after anti-VEGF induction were AVC (53%) and mixed lesions (24%).
Most AMD eyes with classic CNV show capillary lesion on ICGA. In eyes with AMD and classic CNV, the capillary subtype on ICGA appears to be most responsive to intravitreal anti-VEGF injections, while the mixed and AVC subtype respond poorly to anti-VEGF therapy.
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