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Maria K Gemenetzi, Maria Eleftheriadou, Adam Dubis, Simona Degli Esposti, Zaria Ali, Daren Hanumunthadu, Konstantinos Balaskas, Praveen J Patel; Optical coherence tomography angiography in treated neovascular age related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):46. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
In our retrospective study of treated neovascular age related macular degeneration (nAMD) patients the aim was to estimate the proportion of eyes with quiescent CNV on structural OCT and evidence of persistent CNV on optical coherence tomography angiography (OCTA). Also, to characterize the morphology of treated choroidal neovascularization (CNV) in patients receiving anti-VEGF intravitreal injections at different time intervals.
This was a retrospective analysis of OCTA images acquired with the Optovue RTVue XR 100 Avanti Edition and the DRI OCT Triton (Swept Source OCT). We included 21 eyes treated with either aflibercept or ranibizumab on a treat and extend treatment regimen for nAMD and grouped them based on treatment frequency:7 eyes receiving 4-8 weekly injections,6 eyes receiving 10-12 weekly injections, and 8 eyes free of injections for 3-6 months. Images from 6 eyes with dry AMD were obtained as controls. Qualitative features of CNV including presence or absence of CNV and microvascular features of CNV were evaluated.
Of the 7 eyes treated with 4-8 weekly injections CNV was present on OCTA in 4 eyes (57%) and absent in 3 (43%) eyes on OCTA. Globular structures separated by hypodense areas, ‘’dead tree’’ appearance with larger trunk vessels and occasionally small vascular loops were seen. Feeder vessels with clear branching networks and peripheral arcades of the CNV vessel termini were not shown. Of the 6 eyes treated with 10-12 weekly injections a CNV was detected in 5 eyes (83%) presenting with similar microvascular features whereas in one eye (17%) no CNV was detected and outer retinal tubulation was displayed on structural OCT.Of the 8 eyes not treated for 3-6 months CNV was detected on OCTA in 5 of them (62.5%) whereas in 3 eyes (37.5%) no CNV was identified on OCTA. No fluid was present on structural OCT in any of these eyes. Overall the proportion of treated eyes, where CNV could be detected on OCTA, was 66.7% (14 eyes) and CNV was undetectable in 33.3% (7 eyes). No CNV was detected on OCTA in all dry AMD eyes. There was no discrepancy in findings with the 2 different types of OCTA equipment.
More frequent treatment of nAMD led to a greater proportion of eyes with undetectable CNV flow on OCTA. This finding may have clinical relevance when considering stopping anti-VEGF treatment in nAMD eyes with no macular fluid on structural OCT.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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