Detailed optical coherence tomography angiographic short‐term response of type 3 neovascularization to combined treatment with photodynamic therapy and intravitreal bevacizumab

Abstract

Purpose To explore the short‐term vascular and structural changes of type 3 neovascularization using optical coherence tomography angiography (OCT‐A) when treated with a combination of photodynamic therapy (PDT) and intravitreal bevacizumab (IVB), and to evaluate the course of different sequences of the combined therapies. Methods Thirty eyes of 29 treatment‐naïve patients with a type 3 neovascularization were included in this prospective observational cohort study. They were all treated with PDT and IVB 2 weeks apart, starting either with PDT (PDT‐first group) or IVB (IVB‐first group). Optical coherence tomography angiography (OCT‐A) imaging was performed at week 0, 2, 4 and 18, and best corrected visual acuity (BCVA) at week 0 and 18. Vascular, structural and functional features were graded and analysed over time. Results In all patients, at all follow‐up visits, vascular and structural features were significantly more often decreased or resolved than unchanged or increased. Best corrected visual acuity (BCVA) significantly improved at 18 weeks. Vascular, structural and functional outcomes were all slightly better in the PDT‐first group compared to the IVB‐first group, although not statistically significant. Conclusion Combined treatment of PDT and IVB is effective in short‐term for type 3 neovascularization based on vascular and structural features. Initial treatment with PDT tended to be more effective than with IVB.

Intra- and Intergrader Agreement for Detection of OCT Angiographic Characteristics Associated With Type 3 Neovascularization

“…Because we included structural features as well, we were able to compare those characteristics with the current literature. As we previously showed, 9 the specific features that were analyzed in this study may readily be used for staging the type 3 neovascularization. 7 , 15 This study also illustrates the value of a specific aspect of OCT-A assessment, that is, the cross-sectional B-scan evaluation.…”

“…This cross-sectional retrospective agreement study was conducted in the Rotterdam Eye Hospital (Rotterdam, the Netherlands). Images were obtained from an earlier prospective observational cohort study, 9 which was approved by the local internal review board of the Rotterdam Eye Hospital and the Medical Ethical Committee of the Erasmus University Hospital (Rotterdam, the Netherlands). The study followed the tenets of the Declaration of Helsinki.…”

“…Examples of the vascular features are presented in Figure 1 . 9 , 16 , 17 The definition of vascular features was based on the work by De Jong et al 17 and standardized definitions were used for the structural features. 18 Before grading the study images, the graders were presented with examples of each feature, 9 , 17 and the graders were trained on a training set of three other patients that were not included in this study.…”

“…S1 ). 1 , 4 – 9 Distinguishing the different neovascularization types is essential to understand the disease progression, response to therapy, and prognosis. 10 …”

Optical Coherence Tomography Angiography in Intermediate and Late Age-Related Macular Degeneration: Review of Current Technical Aspects and Applications

“…OCTA has also confirmed the efficacy of a combined treatment with photodynamic therapy and anti-VEGF injections, showing a resolution of vascular and structural abnormalities, although this does not always correspond to a visual acuity improvement [94,95].…”