Optical Coherence Tomography Angiography of Treatment-naïve Quiescent Choroidal Neovascularization in Pachychoroid Neovasculopathy

Abstract

Purpose : To estimate the prevalence of treatment-naïve quiescent choroidal neovascularization (CNV) in pachychoroid neovasculopathy(PNV), and investigated the optical coherence tomography angiography (OCT-A) features.

Methods : Treatment-naïve quiescent CNV were identified from a pool of patients with PNV consecutively presenting between January 2016 and June 2016 at two high-volume referral centers (Milan and Creteil). As per standard clinical assessment at both sites, all patients had previously undergone a comprehensive ophthalmologic examination, including fundus biomicroscopy, FA, ICGA, SD-OCT (Spectralis+HRA;Heidelberg-Engineering, Heidelberg, Germany) and OCT-A. Each enrolled patient underwent OCT-A through AngioPlex® CIRRUS HD-OCT model 5000, or AngioVue® RTVue® XR-Avanti.

Results : From a pool of 55 eyes with PNV a total of 6 eyes of 6 patients (mean age: 61.1±9.0 years) met the selection criteria. This accounts for an estimated prevalence of 10.9%(2.7-19.1, 95% CI). In all eyes, treatment-naïve quiescent CNV were characterized by a flat irregular elevation of the retinal pigment epithelium(RPE) with moderately reflective material in the sub-RPE space, no intra/subretinal hyporeflective fluid on OCT. Mean subfoveal choroidal thickness was 399±72 µm for study eyes. Type 1 quiescent CNV were detected in all study eyes by OCT-A and there was agreement of 100% between the two readers (G.Q., A.C.) in the correspondence between ICGA images and OCT-A images. CNV appearing as hypercyanescent neovascular network in early-mid phases of ICGA, was characterized by wash-out in the late phase; also the late hypocyanescent lesion well corresponded to the neovascular network as visualized by OCT-A. The most frequently observed features (well defined margin and irregular shape) were seen in 4 of 6 eyes.

Conclusions : Quiescent CNV in PNV may be suspected by SD-OCT that shows flat irregular elevation of the RPE with moderately reflective material in the sub-RPE space, and by ICGA, that shows the neovascular network in the early-mid phases, then characterized by late wash-out. In the current series, OCT-A was able to clearly demonstrate the presence of treatment-naïve quiescent CNV in all cases, suggesting the utility of its application as a high sensitivity diagnostic tool.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

the late hypocyanescent lesion (ICGA) well corresponding to the neovascular network as visualized by OCT-A