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N. J. Mehta; Evaluation of Choroidal Circulation Using Collapsed C-Scan (en face) Imaging Derived from Meta-Analysis of 3D Spectral-Domain (Fourier-Domain) OCT Utilizing Automated Image Processing in Patients Undergoing Combination Therapy With Verteporfin (Visudyne®) and Ranibizumab (Lucentis®) for Exudative AMD. Invest. Ophthalmol. Vis. Sci. 2009;50(13):353.
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To evaluate the choroidal circulation using a novel, computer-assisted choroidal image analysis algorithm applied to spectral-domain (Fourier-domain) OCT images in patients treated with combination verteporfin and ranibizumab therapy.
A retrospective review of spectral-domain OCT results obtained between November 2006 and November 2008 was performed for nine eyes from eight patients with occult and/or classic subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD), and Snellen visual acuity of at least 20/200. These eyes received at least one verteporfin treatment (standard fluence) and at least four monthly intravitreal ranibizumab injections. Ranibizumab preceded verteporfin treatment by approximately 1-2 weeks.En face (C-scan) OCT images, collapsed and summated in the antero-posterior axis, were acquired for all patients over approximately monthly intervals throughout their treatment regimen. These images were standardized and analyzed using proprietary image analysis software which first isolates the choroidal vascular pattern, differentiating the same from background scatter phenomenon, and then automatically quantifies this pattern in proportion to the entire scanned area.
Graphic analysis of chronologically sequential images shows a trend toward decreased choroidal vascular prominence, consistent with increasingly impaired choroidal perfusion, in 7 of 9 (78%) eyes undergoing combination therapy over time; this observation has been validated in other studies. When comparison is made to visual acuity upon initiation of treatment, two eyes (22%) had an increase of more than one line, two eyes (22%) had a decrease of more than one line, and five eyes (56%) remained within one line of their pre-treatment acuities. The two eyes with decreased acuities were the same eyes without a clear trend toward decreased choroidal prominence.
This study establishes the feasibility of a new, automated technique for the evaluation of spectral-domain OCT data utilizing image meta-analysis to demonstrate a decreasing choroidal circulatory pattern in patients who are being treated with combination therapy for exudative AMD. This downward trend is not seen in corresponding visual acuities.This novel technique is furthermore being applied to patients with other macular diseases, including non-neovascular AMD, central serous retinopathy and diabetic retinopathy, in addition to patients undergoing ranibizumab monotherapy.
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