Optical coherence tomography angiography study of submacular hemorrhage and choroidal neovascularization secondary to pathological myopia

Abstract

Purpose : To investigate the morphology of macular hemorrhage and choroidal neovascularization (CNV) secondary to pathologic myopia using swept source optical coherence tomography angiography (OCTA).

Methods : Methods: Observational cross-sectional study of 15 eyes of 14 patients diagnosed with macular hemorrhage or myopic CNV who presented at an academic eye clinic. All eyes underwent OCTA assessment, and their morphologic appearances were evaluated in correspondence with conventional imaging modalities.

Outcomes: The presence or absence of CNV lesion and the structure of neovascular network in OCTA. Using leakage on fluorescein angiography (FA) as a reference, the sensitivity of OCTA in detecting myopic CNV was estimated.

Results : Results: The mean ± standard deviation spherical equivalent refractive error of the eyes was -11.08 ± 2.26 diopters. Simple macular hemorrhage without CNV was diagnosed in 3 eyes and OCTA clearly displayed the normal vascular plexus without CNV network. Of the 12 eyes which had myopic CNV, OCTA identified the CNV complex in 8 eyes (sensitivity of 66.7%). The mean greatest linear diameter of myopic CNV was 546 ± 198.1 µm. Vascular anastomosis within the CNV was well circumscribed, compact and surrounded by a dark halo. Large trunk vessels were lacking and the caliber of vessels were homogenously tiny and comparable to the surrounding capillaries. OCTA could not distinguish active leaking myopic CNV from quiescent lesion. OCTA was also unable to delineate lacquer cracks and CRA appeared as a window defect similar to its appearance on FA.

Conclusions : This study demonstrated the utilization of OCTA in macular hemorrhage and CNV secondary to pathologic myopia. Although FA remains the gold standard for determining the presence of leakage, OCTA enables noninvasive evaluation of the precise structure of myopic CNV.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

(A) Red-free fundus photo of a myopic CNV (large arrow) with adjacent hemorrhage (small arrow). Comparing with early phase FA (B), the leakage obscured the border of the CNV in late phase FA. (D) In ICGA, the vascular network was surrounded by a dark halo. (E) SD OCT revealed subretinal fluid. OCTA segmentation at inner retina layer (F), outer retina (G) and outer aspect of Bruch’s membrane (H). (G) OCTA revealed vascular anastomosis of the CNV next to foveal avascular zone (small arrow), without interference by adjacent hemorrhage.