Comparison of different morphologies of choroidal neovascularization evaluated by ocular coherence tomography angiography in age‐related macular degeneration

Abstract

Importance: The clinical implications of different morphologies of choroidal neovascularization (CNV), as evaluated by ocular coherence tomography angiography (OCTA) in neovascular age-related macular degeneration (nAMD), are lacking. Background: To describe the morphology of CNV in nAMD using OCTA, and to compare the visual prognosis and other structural OCT biomarkers between different morphologic patterns. Design: Retrospective cohort study. Participants: One hundred and forty eyes with nAMD treated with anti-vascular endothelial growth factor (VEGF). Methods: Patients were examined using OCTA prior to and at 3, 6 and 12 months after receiving anti-VEGF therapy. Main Outcome Measures: Best-corrected visual acuity (BCVA) and morphologic retinal features. Results: Organized CNV was identified in 110/140 eyes (78.6%) using OCTA. These CNV complexes could be divided into three OCTA patterns: the 'medusa' pattern (n = 41), characterized by branching vessels radiating in all directions; the 'seafan' pattern (n = 43), characterized by branching vessels radiating to one side of the lesion; and the 'tangled' pattern (n = 26), characterized by globular entwined vessels without a main trunk. At baseline, the eyes with the tangled pattern were from younger patients (P = .031) with better BCVA (P = .007). There were also fewer intraretinal cysts (P = .021), less fibrovascular pigment epithelial detachment (P = .009), and more pachychoroid (P = .007) in eyes with the tangled pattern on OCT. At 12 months post-treatment, patients with the tangled CNV pattern also showed greater visual improvement than patients with the other two patterns (P = .049).

Comparative quantitative analysis of optical coherence tomography angiography in varied morphologies of macular neovascularization following intravitreal conbercept and ranibizumab treatments for neovascular age‑related macular degeneration

“…In the present study, 27.2% of eyes exhibited the Medusa pattern, 36.3% the seafan pattern, 22.7% the tangled pattern and 13.6% another pattern (i.e., ill-defined but measurable MNV). Consistent with Tew et al ( 16 ), there was a higher proportion of eyes with the seafan pattern in the present study ( 27 ).…”

“…Tew et al ( 16 ) further differentiated and reported tangled pattern complexes with a main trunk or feeder vessel. In their study of 140 eyes, they identified MNV in 78.6%, with 37.3% displaying the Medusa pattern, 39.1% the seafan pattern and 23.6% the tangled pattern.…”

“…Morphological patterns of the MNV complex on OCTA were systematically examined and categorized into four groups: i) The ‘Medusa’ pattern, characterized by branching vessels radiating in all directions from the main vessel trunk at the center; ii) the ‘seafan’ pattern, defined as a lesion with branching vessels radiating from one side of the main vessel trunk; iii) the ‘tangled’ pattern, described as a lesion with globular structures of entwined vessels without a discernible main vessel trunk ( 16 ); and iv) the ‘other’ pattern, encompassing lesions with irregular vessels that cannot be attributed to the aforementioned three forms but remain measurable.…”

Dilated choroidal vascular channels in pachychoroid neovasculopathy

“…The MNV was further outlined using the “contour function” of the built‐in software, and the flow area was determined automatically (Figure S2). We calculated MNV vessel density (%) as the percentage of the measured area occupied by flow area 16 . En face OCT and OCTA of the deep choroid were obtained using manual adjustment, with the upper boundary aligned to the junction between Sattler's and Haller's layers, and the lower boundary aligned with the choroidal‐scleral interface.…”

The imaging revolution

“…Yang et al 12 show the value of ultra‐widefield imaging for detection of peripheral retinal lesions in high myopia before implantable collamer lens surgery. Tew et al 13 identify different patterns of choroidal neovascularisation in age‐related macular degeneration – with different visual prognoses – using OCT‐angiography.…”