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Jonathan Chou, Errol Chan, Joseph Simonett, Amani A Fawzi; A New Quantitative Approach in Analyzing Polypoidal Choroidal Vasculopathy In Vivo Using En Face Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4257.
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© ARVO (1962-2015); The Authors (2016-present)
To describe a new approach for quantifying the polypoidal choroidal vasculopathy (PCV) lesions and to monitor their response to anti-VEGF therapy using en face volumetric spectral domain optical coherence tomography.
A total of 13 eyes from 12 patients with a clinical diagnosis of PCV were analyzed. We used the macular volume scan (6x6mm cube) reviewed on Cirrus (Carl Zeiss Meditec Inc, Dublin, CA) to identify pigment epithelial detachments, subretinal fluid, and vascular lesions seen in the disease process. OCT slab function was used to create a topographic map following the contour of the RPE. The entire neovascular PCV lesion (including polyps, branching vascular network and pigment epithelial detachment) was identified as a hypo-reflective network. ImageJ was used for all analysis. Two masked graders created a topographic binary map of the PCV lesions by thresholding the en face image to isolate the hypo-reflective areas. The total lesion area was compared between the two graders to determine inter-rater reliability. Further analysis compared lesion areas in patients before and after an anti-VEGF induction series of 1-8 injections (ranibizumab or bevacizumab). Pearson correlation coefficient, Bland-Altman scale, and a student t-test with a p-value <0.05 were used in the statistical analysis.
Inter-rater reliability for lesion area measurements had a Pearson correlation of 0.960. Of the 13 eyes, 10 had no prior history of treatment. The en face lesion area decreased from 2.75 mm2 to 2.22 mm2 after anti-VEGF injections (p = 0.047). 3 eyes had previously been treated with photodynamic therapy. In these eyes, the lesion area decrease was not statistically significant (2.66 mm2 to 2.21 mm2). In a sub-group analysis comparing patients treated with ranibizumab vs. bevacizumab, there was no statistical difference in the reduction of the lesion area (-0.43 mm2 to -0.58 mm2, respectively)
Using SD-OCT, we have described a new approach for accurately quantifying the entire pathology seen in PCV with good inter-rater reliability. With this technique, we have shown a significant reduction in PCV lesion area following anti-VEGF therapy in treatment-naive eyes.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
A) SD-OCT b-scan showing multiple RPE elevations suggestive of polypoidal lesions, subretinal fluid and fibrin deposits. B) Corresponding en face OCT slab at the level of the RPE.
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