Longitudinal assessment of choroidal neovascularization in patients treated with anti-VEGF for choroidal neovascularization using optical coherence tomography angiography

Abstract

Purpose : To assess changes in greatest linear dimension (GLD) of treated choroidal neovascularization (CNV) as measured using optical coherence tomography angiography (OCTA) in a dataset with 3.5 years of consecutive OCTA follow-up.

Methods : A single center, retrospective analysis of patients treated for CNV with anti-vascular endothelial growth factor (anti-VEGF) drugs at the University of Illinois at Chicago. 1227 photography records of 405 patients with a diagnosis of CNV imaged on the OptoVue Avanti OCTA (Fremont, CA) from April 2016 to October 2019 were reviewed. OCTA scans were stringently selected to include images which captured the entire lesion and were free of OCTA artifacts. Images were manually segmented and GLD of the lesion was measured using ImageJ software (National Institutes of Health, Bethesda, MD). Figure 1 demonstrates an example of GLD measurements.

Results : 25 patients (17 women) with a mean age of 69.8 years had CNV with OCTA images that met the inclusion criteria. CNV associated diagnoses included 19 neovascular age-related macular degeneration, 2 myopia, 2 idiopathic, 1 macular telangectasia, and 1 choroidal rupture. 22 CNV were treated prior to the first OCTA image (average 13 prior injections, range 1-52). Mean follow-up interval was 2.06 years (range 90-1234 days) with a mean of 10.9 injections (range 1-37).The average change in GLD was +34.26 mm (range -133 to +318 mm). The mean change in GLD of treated lesions was +34.2 mm and +123 mm in the treatment-naïve lesions. A paired t-test demonstrated a nonsignificant difference in the GLD of the CNV between the first and last images (p=0.24). The scatterplot in Figure 2 demonstrates no significant correlation between the absolute GLD difference and number of interval injections (R²= 0.05, adjusted R²= 0.009)

Conclusions : Anti-VEGF has been described as a mediator of vascular pruning of immature vessels and increased vascular maturity. Changes in CNV morphology following treatment have been previously described, including shrinkage of peripheral and fine vessels. Few studies have longitudinally evaluated changes in CNV. The results suggest that GLD is an OCTA parameter that is not predictive of treatment burden and that with further treatment, GLD does not change significantly in patients with previously treated CNV.

This is a 2020 ARVO Annual Meeting abstract.

 

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