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Philipp Ken Roberts, Stefan Zotter, Alessio Montuoro, Michael Pircher, Bernhard Baumann, Stefan Sacu, Christoph K Hitzenberger, Ursula Schmidt-Erfurth; Detection of the angiofibrotic switch in neovascular AMD: A quantitative analysis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2622.
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© ARVO (1962-2015); The Authors (2016-present)
To quantify volumetric changes of subretinal hyperreflective material (SHRM) towards subretinal fibrosis and determine the angiofibrotic switch under anti-VEGF therapy.
Patients with treatment-naïve nAMD were included in this prospective observational study. The diagnosis was made based on clinical examination, spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA). Patients were imaged at baseline and after 3 months (after treatment with 3 intravitreal anti-VEGF injections) using a polarization-sensitive OCT (PS-OCT) system with a scanning angle of 30x30° and a scan pattern of 250x1024 A-scans. The device is capable of automatically detecting fibrosis and the retinal pigment epithelium (RPE) based on their birefringent and depolarizing properties, respectively. The change of the volume of SHRM over time was quantified by manual delineation in each PS-OCT B-scan and the occurrence of fibrosis was detected based on tissue birefringence.
50 eyes of 49 patients were included in the study, 28 of which had SHRM and 3 had some degree of subretinal fibrosis at baseline. In seven of these eyes subretinal fibrosis was detected at 3 months, 6 of which could be unambiguously detected based on PS-OCT imaging. All of these eyes demonstrated non-fibrotic SHRM at baseline, which converted to subretinal fibrosis until month 3. The volume, area and maximum thickness of SHRM decreased significantly from baseline to month 3 (p<0.01) and SHRM regressed completely in 7 eyes without developing fibrosis.
SHRM volume decreases significantly during anti-VEGF therapy, however, the conversion to subretinal fibrosis occurs in a subset of eyes as early as during the first three months of anti-VEGF treatment and can be detected by PS-OCT imaging.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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