Analysis of choroidal neovascular membranes in white dot syndromes vs. age-related macular degeneration using optical coherence tomography angiography.

Abstract

Purpose : To compare the structural characteristics and treatment response of choroidal neovascular membranes (CNVM) in white dot syndromes (WDS) with CNVM secondary to age-related macular degeneration (AMD) using optical coherence tomography angiography (OCT-A).

Methods : This retrospective case-control study was approved by the Massachusetts Eye and Ear Institutional review board and conformed to the provisions of the Declaration of Helsinki. Consecutive patients with active CNVM secondary to WDS and AMD were imaged with either Zeiss Angioplex OCT-A (Carl Zeiss AG, Germany) or Optovue AngioVue OCT-A (Fremont, CA) from February 2016 to January 2017. OCT-A images were analyzed by a masked grader (JW). Measurement of CNVM area and vessel density was performed in ImageJ (NIH, Bethesda, MD). CNVM area and vessel density were compared between patients using multilevel regression. We also compared CNVM area and vessel density in WDS patients before and after intravitreal anti-Vascular Endothelial Growth Factor (VEGF) injections. All statistical analyses were performed with STATA 12.1 (College Station, TX).

Results : Four eyes of 4 patients with WDS and 15 eyes of 13 patients with exudative AMD were included. In patients with WDS, the average CNVM area and vessel density before intravitreal anti-VEGF therapy were 0.30 mm² and 0.35, respectively. In AMD patients, the average CNVM area and vessel density were 2.5 mm² and 0.32, respectively. CNVM area was smaller in WDS patients compared with AMD patients and this difference was statistically significant (β = -2.29, p = 0.01). Mean CNVM density was not significantly different between the two groups (β = 0.03, p = 0.57). In WDS patients, the average CNVM area and vessel density after intravitreal anti-VEGF therapy were 0.18 mm² and 0.34, respectively, and were not significantly different compared with values before treatment (p = 0.45 and p = 0.86, respectively).

Conclusions : In this study, we found that WDS-associated CNVM were smaller in size but similar in vessel density compared to CNVM of exudative AMD. In WDS patients, we found no statistically significant difference in OCT-A parameters in response to treatment, but recognize that this was only a small sample size. Additional longitudinal studies of these inflammatory CNVM may help us develop better treatment strategies.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.