July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Selective differentiation of RPE, fibrosis and choroidal neovascularization (CNV) – a multimodal imaging study
Author Affiliations & Notes
  • Philipp Ken Roberts
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
  • Markus Schranz
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
  • Sylvia Desissaire
    Center for Medical Physics and Biomedical Engineering, Austria
  • Michael Pircher
    Center for Medical Physics and Biomedical Engineering, Austria
  • Georgios Mylonas
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
  • Magdalena Baratsits
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
  • Stefan Sacu
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
  • Christoph K Hitzenberger
    Center for Medical Physics and Biomedical Engineering, Austria
  • Ursula Schmidt-Erfurth
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
  • Footnotes
    Commercial Relationships   Philipp Roberts, Canon Inc. (F); Markus Schranz, None; Sylvia Desissaire, None; Michael Pircher, Canon Inc. (F); Georgios Mylonas, None; Magdalena Baratsits, None; Stefan Sacu, None; Christoph Hitzenberger, Canon Inc. (F); Ursula Schmidt-Erfurth, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3467. doi:
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      Philipp Ken Roberts, Markus Schranz, Sylvia Desissaire, Michael Pircher, Georgios Mylonas, Magdalena Baratsits, Stefan Sacu, Christoph K Hitzenberger, Ursula Schmidt-Erfurth; Selective differentiation of RPE, fibrosis and choroidal neovascularization (CNV) – a multimodal imaging study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3467.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To determine extension and configuration of vascular and fibrous components of choroidal neovascularization (CNV) lesions and the RPE by multimodal imaging.

Methods : 30 eyes of 30 consecutive patients with a minimum history of 12 months of anti-VEGF treatment for neovascular age-related macular degeneration (AMD) were included in this cross-sectional study.
Patients were imaged using a swept-source optical coherence tomography angiography (OCTA) device for comprehensive evaluation of the neovascular complex. Furthermore, a novel polarization-sensitive OCT (PS-OCT) system with an integrated eye-tracker was used to automatically segment fibrous components of the lesion as well as the RPE based on tissue-specific contrast. Microperimetry with color fundus photography was performed for functional mapping. After co-registration of OCTA and PS-OCT scans, location, size and density of vessels were assessed and compared to the configuration of fibrosis and the condition of the RPE.

Results : Of 30 eyes included in the study, 18 eyes were diagnosed with fibrosis based on clinical examination and PS-OCT imaging. Neovascular nets were preserved within areas of subretinal fibrosis in all eyes and the area of fibrosis matched the center of the CNV in 89% of cases (16/18). Furthermore, fibrosis was observed adjacent to medium and large sized vessels rather than small sized vessels (i.e. capillaries). Vascular channels could be localized anterior to fibrosis (2 eyes; 11%), posterior to fibrosis (9 eyes; 50%) or sandwiched within fibrotic components (7 eyes; 39%). An intact RPE layer was observed in 2 eyes (11%), a discontinuous RPE layer in 4 eyes (22%) and atrophy of RPE was observed in 12 eyes (67%) in the area of fibrosis. However, clusters of RPE cells within the fibrotic complex were observed in all cases.

Conclusions : Multimodal imaging enables precise identification of spatial correlation of vascular channels and fibrotic and RPE components in CNV lesions. Fibrosis has a predilection to develop in the center (=the presumably oldest component) of the CNV lesion surrounding the medium and large vessels. The RPE layer is mostly absent in areas of fibrosis with residual RPE clusters suggesting a transdifferentiation of RPE cells to myofibroblasts.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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