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G. Raymond, T. L. Gray, S. N. Sinkar, J. S. Muecke, J. S. Gilhotra; A Comparison of Optical Coherence Tomography With Fundus Fluorescein Angiography for Monitoring Recurrence of Choroidal Neovascularization During Treatment of Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4377.
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The purpose of this trial was to compare the accuracy of optical coherence tomography (OCT) with fundus fluorescein angiogram (FFA) in detecting active leakage from choroidal neovascularization (CNV) in age-related macular degeneration (AMD).
This was a post-hoc analysis of data from a prospective trial in which 19 patients with exudative AMD and treated with photodynamic therapy (PDT) combined with lucentis intravitreal injections had 6 weekly OCT and FFA for 12 months. A retinal specialist masked to any additional clinical information analysed the OCT and FFA images independently from each other to assess for signs of active disease. OCT images were said to be positive for active disease if there was subretinal or intraretinal fluid, thickening greater than 300um or an increase of greater than 50um from the previous scan. FFA was considered positive for signs of active CNV if there was fluorescein leakage and/or an increase in CNV size.
Of the 19 patients that completed the study, 9 were male, 10 were female. 14 had predominantly classic and 5 had minimally classic or occult CNV. All patients received one session of PDT at the beginning of the trial and an average of 5.4 injections of Lucentis over the 12 month follow-up. There were 160 assessments in which good quality OCT and FFA images were obtained on the same day. In 132 of these assessments there were signs of active CNV. 103 (78%) had OCT and 121 (92%) had FFA evidence of active leakage (p<0.005).
OCT alone is likely to miss 22% of active CNV recurrence compared with FFA combined with OCT when monitoring patients being treated for exudative AMD.
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