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Rachel C. Patel, Simon S. Gao, Miao Zhang, Talal Alabduljalil, Abdullah Aoun Alqahtani, Yali Jia, David Huang, Paul Yang, Mark E Pennesi; Optical coherence tomography angiography of choroidal neovascularization in inherited retinal dystrophies. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2163. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Optical coherence tomography (OCT) angiography provides a novel, noninvasive method of evaluating retinal vasculature. We performed a retrospective case series of patients with inherited retinal dystrophies (IRD) complicated by choroidal neovascularization (CNV) to determine the clinical utility of OCT angiography in degenerative disorders, characterize angiographic morphology, and perform sequential quantitative analysis concurrent with bevacizumab therapy.
We identified four IRD patients presenting with choroideremia, EFEMP1-related retinopathy, Best vitelliform macular dystrophy, and adult-onset vitelliform dystrophy (AOVD) and complicated by CNV. They were evaluated with OCT angiography using a 70 kHz spectral domain OCT system employing the split-spectrum amplitude-decorrelation angiography (SSADA) algorithm. Semi-automated segmentation delineated the CNV in each eye and automated software quantified the area and vessel density of the lesion. Two of the four patients (those with choroideremia and EFEMP1-related retinopathy) underwent treatment with intravitreal bevacizumab and were evaluated by OCT angiography at corresponding intervals.
Neovascular flow was observed within areas of subretinal fibrovascular tissue. In the patient with AOVD, fluorescein angiography was indeterminate but OCT angiography demonstrated the presence of flow through the lesion. CNV morphology varied from long vascular loops devoid of fine branches to dense capillary networks. The area of the neovascular vessels ranged from 0.07 to 0.98 mm2. Following intravitreal bevacizumab injection, the visualization of the neovascular capillaries notably decreased while the larger vessels were relatively unchanged.
OCT angiography enables the morphological characterization and quantification of CNV in patients with retinal dystrophies despite distorted retinal architecture, supplementing information derived from fluorescein angiography. Intravitreal bevacizumab may alter CNV architecture particularly by pruning or decreasing flow through capillary branches, but long-term therapy did not result in vascular normalization in our two cases. Serial OCT angiograms may provide morphological and quantitative guidance for treatment of neovascularization.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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