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Simone Tzaridis, Kristina Hess, Martin Friedlander, Frank G Holz; Optical coherence tomography angiography for treatment monitoring of neovascularizations secondary to macular telangiectasia type 2 (MacTel). Invest. Ophthalmol. Vis. Sci. 2020;61(7):4808.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate if optical coherence tomography-angiography (OCT-A) is appropriate for monitoring activity, progression and treatment effects of neovascularizations (NVs) secondary to macular telangiectasia type 2 (MacTel).
In a retrospective analysis, eyes with NVs secondary to MacTel were reviewed over a period of ≥8 months. Examinations at monthly intervals included visual acuity testing, dilated funduscopy, Spectral Domain-OCT (SD-OCT) and OCT-A. Eyes were treated with intravitreal VEGF (vascular endothelial growth factor)-inhibitors following a pro-re-nata (PRN) regime, and treatment decisions were based on morphological clinical signs of activity as determined by SD-OCT and funduscopy. Signs of neovascular activity were defined as increase of retinal thickness, presence/ increase of intraretinal/ subretinal fluid and hemorrhages.
A total of 19 eyes of 17 patients were analyzed. Patients were followed up for a mean period of 13.4 months (range: 8.9-24.2). OCT-A allowed to monitor both treatment effects (regression) and progression (growth) of NVs, but not neovascular activity. Notably, the growth of neovascular vessels was detectable in OCT-A before signs of activity occurred on OCT. NVs showed a progressive growth over time despite of PRN-treatment and preferentially grew and extended within areas exhibiting a focal reduction of choriocapillaris perfusion. With disease progression changes in the course and appearance of vessels were observed at the level of both the choroidal and the retinal microvascular systems as determined by OCT-A.
The results indicate OCT-A as helpful imaging modality for monitoring NV-progression and treatment effects in MacTel. We demonstrate its advantages over conventional B-scan OCT imaging, including an earlier detection of NV-progression, and propose an adjustment of the current OCT-controlled PRN treatment regime in order to prevent NV-progression and subsequent functional loss in MacTel.
This is a 2020 ARVO Annual Meeting abstract.
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