Optical Coherence Tomography Angiography-Based Quantitative Assessment of Morphologic Changes in Active Myopic Choroidal Neovascularization During Anti-vascular Endothelial Growth Factor Therapy

Abstract

Purpose: To establish quantitative profile of the morphologic changes among patients with active myopic choroidal neovascularization (mCNV) before and after anti-vascular endothelial growth factor (VEGF) therapy using optical coherence tomography angiography (OCTA) to assess the therapeutic response.Methods: Patients with active mCNV who received anti-VEGF injections between February 2017 to October 2020 and fit the study criteria were retrospectively reviewed. Quantitative analysis of their OCTA images were carried out to evaluate the morphologic features and vascular changes of mCNV lesions in response to anti-VEGF therapy. For further quantitative profiling, mCNV area, fractal dimension, vessel area, vessel density, vessel diameter, vessel length, vessel junction, junction density, and vessel tortuosity were obtained by means of advanced skeletonization postprocessing analyses.Results: Thirty-one eyes of 29 consecutive patients with OCTA-positive mCNV lesions (mean spherical equivalent: −12.55 ± 3.24 diopters) were included. The 31 cases were divided into two phenotypes at baseline: organized interlacing pattern (83.87%) and disorganized vascular loops pattern (16.13%). The values of mCNV area, fractal dimension, vessel area, vessel length, vessel junction, and junction density decreased remarkably 1 month after the initial anti-VEGF injection (p < 0.001). Although, vessel density, vessel diameter, and vessel tortuosity increased meanwhile, only vessel diameter displayed statistical significance (p = 0.027). Of note, relative ratio analysis showed that vessel junction was the most sensitive biomarker in response to anti-VEGF therapy, reflecting a mean decrease of 50.36%. Sensitivity lowered successively in biomarkers of vessel length, vessel area, junction density, mCNV area, and fractal dimension. In addition, percent change of mCNV area (r = 0.552, p = 0.002), fractal dimension (r = 0.446, p = 0.017), vessel area (r = 0.518, p = 0.005), and vessel length (r = 0.440, p = 0.019) were moderately associated with that of central retinal thickness.Conclusions: The study showed morphological as well as quantitative changes on OCTA responding to anti-VEGF treatment in mCNV patients, among which vessel junctions might be the most predictive biomarker. OCTA-based analysis, providing intuitive images and a large spectrum of quantitative data at the same time, could promote new insights into the therapeutic response assessment in mCNV patients.

Performance Assessment of Two Different Approaches of Measuring Skeletonized Radial Peripapillary Capillary Vessel Density in Glaucoma Patients

“…To the best of our knowledge, although skeletonization has already been used in some vascular research ( 18 – 20 ), our study is the first to compare the performance of different approaches for skeletonization. Through the comparison of the two approaches in the clinical setting, an alert has been aroused that different image processing procedures might influence the analysis.…”

“…With applicable image-analysis software, skeletonization of the vessels can reduce the width of the vessels to a single pixel, eliminating related variability of vessel density caused by different vessel calibers ( 16 ). Several studies have measured the VD after skeletonization to study the characteristics of ocular diseases ( 17 – 20 ). However, to the best of our knowledge, there is a lack of study that helps assess the performance of different skeletonization methods and determine which method shows the higher correlations with the clinical findings.…”

Novel Findings of Retinal and Choroidal Features Utilizing Optical Coherence Tomography Angiography Analysis in Patients With Autoimmune Posterior Uveitis

“…All patients and NCs were imaged with the AngioVue Imaging System (RTVue XR Avanti; Optovue, Inc., Fremont, CA) ( 16 ) by the same experienced examiner. OCTA image analysis covering the 4.5 mm × 4.5 mm area centered on the papilla and the 6 mm × 6 mm area centered on the fovea was performed.…”

Advances in OCT Imaging in Myopia and Pathologic Myopia

“…Interestingly, researchers found an excellent agreement in mCNV area measurements and a poor agreement in mCNV vessel density measurements for SS-OCTA devices in automatic and manual segmentations [ 96 ]. In addition, OCTA is also useful to evaluate the anti-vascular endothelial growth factor (VEGF) therapy for mCNV [ 97 , 98 , 99 ], in which the vessel junctions may be one of the most important biomarkers [ 100 ]. OCTA-based analysis generated both intuitive images and quantitative data, which could lead to new perceptions of treatment response evaluation for mCNV [ 100 ].…”

“…In addition, OCTA is also useful to evaluate the anti-vascular endothelial growth factor (VEGF) therapy for mCNV [ 97 , 98 , 99 ], in which the vessel junctions may be one of the most important biomarkers [ 100 ]. OCTA-based analysis generated both intuitive images and quantitative data, which could lead to new perceptions of treatment response evaluation for mCNV [ 100 ]. However, OCTA bears several limitations.…”