Optical coherence tomography findings predictive of choroidal neovascularization(CNV) activity in pathologic myopia: correlation with fluorescein angiography in korean patients.

Abstract

Purpose : Evaluating disease activity is essential for determining the proper treatment of myopic choroidal neovascularization (CNV). While fluorescein angiography (FA) is the most sensitive tool for CNV detection, its invasiveness limits frequent follow-up examination; furthermore, presence of lacquer crack or subretinal hemorrhage can interrupt proper visualization. Optical coherence tomography (OCT) is a helpful diagnostic tool; however, the correlation between OCT findings and disease activity remains unclear. Therefore, the aim of this study is to evaluate the OCT findings for CNV in assessment of disease activity in association with FA findings.

Methods : This was a retrospective study including 30 patients with myopic CNV who were treated with intravitreal anti-VEGF(bevacizumab) between January 2013 and July 2015. All patients underwent OCT and FA examination before and 1 month after intravitreal anti-VEGF treatment for active myopic CNV. We analyzed potential OCT features suggestive of the disease activity as follows: presence of intraretinal cysts, subretinal fluid, CNV height, and fuzziness of CNV border on OCT. CNV network area was also measured on FA. Logistic regression analysis was performed to evaluate the correlation between CNV parameters seen on OCT with leakage degree on FA.

Results : After intravitreal anti-VEGF injection, OCT revealed statistically meaningful improvement of intraretinal cysts in 10 eyes (21.73%), subretinal fluid in 9 eyes (19.57%) and fuzziness of CNV border in 21 eyes (45.65%) (p=0.006, 0.007, <0.001). The height of CNV lesion decreased significantly from 146.60 ± 68.33 μm to 118.02 ± 55.73 μm (p<0.001). FA showed statistically significant reduction of CNV network area from 0.73 ± 0.97 mm2 to 0.50 ± 0.89 mm2 (p=0.003). Fifteen eyes (32.61%) showed remarkable resolution of active leakage on FA (p<0.001). Fuzzy border seen on OCT revealed the most significant correlation with leakage on FA (p=0.009, R2 = 0.324).

Conclusions : Our study demonstrated that the fuzzy border of CNV is the most common visible finding on SD-OCT and showed the most prominent improvement after intravitreal anti-VEGF injection. Furthremore, it showed the strongest correlation with changes of CNV leakage on FA. Thus, fuzzy CNV border can be considered the most important feature for assessment of CNV activity.

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