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B. E. Cribbs, G. Hubbard, III; Active Choroidal Neovascularization in the Absence of Qualitative Optical Coherence Tomography Findings: A Case Series. Invest. Ophthalmol. Vis. Sci. 2008;49(13):300.
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to describe the features of a series of patients with active choroidal neovascularization but no characteristic findings of lesion activity on optical coherence tomography (OCT) imaging.
5 eyes of 5 patients with active choroidal neovascularization as determined by fluorescein angiography (FA) but without characteristic OCT findings of lesion activity (retinal edema or cysts, subretinal fluid, or sub-retinal pigment epithelium fluid) were retrospectively identified. Patient demographics, clinical findings, and features of FA and OCT imaging were evaluated.
Mean patient age was 66.4 (range 48-85). Disease etiology was age-related macular degeneration in 3 cases (60%), ocular histoplasmosis syndrome in 1 case (20%), and juxtafoveal telangiectasia in 1 case (20%). 4 patients (80%) had undergone previous treatment for active choroidal neovascularization including focal laser in 2 cases (40%), photodynamic therapy in 3 cases (60%), and intravitreal triamcinolone injection in 4 cases (80%). Mean visual acuity was 20/130 (range 20/50 - 20/300). All patients experienced new onset of symptoms, which included blurred vision in 2 cases (40%), metamorphopsia in 2 cases (40%), and scotoma in 1 case (20%). Clinical evidence of subretinal hemorrhage was found in 1 case (20%). All patients had fluorescein angiographic evidence of leakage: subfoveal in 2 cases (40%) and juxtafoveal in 3 cases (60%). Mean central macular thickness was 174 microns by OCT (range 159-180). OCT findings of subretinal hyper reflectivity in 2 cases (40%) and retinal pigment epithelium (RPE) layer irregularity in 3 cases (60%) were identified. None of the cases exhibited findings of retinal edema or cysts, subretinal fluid, or sub-RPE fluid.
Active choroidal neovascularization may be present in the absence of qualitative OCT findings, especially in the setting of previously treated lesions. A combination of criteria including patient symptoms, clinical findings of new hemorrhage, and fluorescein angiography should be used in addition to qualitative OCT to identify patients that may benefit from choroidal neovascularization therapy.
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