Optical Coherence Tomography Angiography of Choroidal Neovascularization and Inflammatory Pigment Epithelial Detachments Occurring in Idiopathic Multifocal Choroiditis.

Abstract

Purpose : To describe the spectral-domain optical coherence tomography angiography (SD-OCTA) patterns observed in idiopathic multifocal choroiditis (MFC) with and without inflammatory pigment epithelial detachment (PED) or choroidal neovascularization (NV).

Methods : Multimodal imaging using spectral-domain optical coherence tomography, fundus autofluorescence imaging, fluorescein angiography and SD-OCTA (RTVue XR Avanti, Optovue, Inc., Fremont, CA; Cirrus Angioplex OMAGC, Carl Zeiss Meditec, Dublin, CA) was performed to evaluate inflammatory PEDs suspicious for NV in patients with active (with or without prior treatment) and inactive MFC from two retinal practices.

Results : Fifteen eyes of 10 patients (8 women) with non-infectious idiopathic MFC were evaluated. Four eyes without ocular inflammation with active NV despite prior treatment demonstrated either well-defined, medium-sized vessels (30-50 μm, n=2) or fine small vessels in a larger, less well-defined area (20-30 μm, n=2). One patient with active ocular inflammation and previously untreated NV demonstrated fine, medium caliber vessels in 1 eye; her other eye had previously treated recurrent NV. Both eyes were treated with intravitreal aflibercept and, four weeks after treatment, both eyes exhibited pruning of vessel size and change in NV complex morphology into a reduced number of large trunks with numerous small branches; 1 eye exhibited reduction in greatest linear diameter of the NV complex (1.42 to 1.22 mm). One eye from another patient demonstrated an active inflammatory PED that did not exhibit NV on SD-OCTA, which resolved following sub-Tenon’s triamcinolone. The choriocapillaris underneath the inflammatory lesion exhibited reduced flow that improved with treatment. Five eyes with a history of previously treated but currently inactive NV demonstrated either no vessels or non-neovascular, thickened choroidal vessels in areas of atrophy/scarring on SD-OCTA. Three eyes without a history of NV did not show active or inactive NV in areas of fibrovascular scars on SD-OCTA.

Conclusions : SD-OCTA facilitates diagnosis and monitoring of NV in MFC and can help distinguish between acute inflammatory PED, quiescent fibrotic lesions and active NV.

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