Optical coherence tomography angiography in age‐related macular degeneration: persistence of vascular network in quiescent choroidal neovascularization

Wirth, Magdalena A.; Freiberg, Florentina Joyce; Pfau, Maximilian; Wons, Juliana; Becker, Matthias; Michels, Stephan

doi:10.1111/aos.13226

Cited by 11 publications

(9 citation statements)

References 6 publications

(8 reference statements)

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“…In concordance with their findings, the CNV detection rate on SS-OCTA in this study was high (92%) in eyes complicated by nAMD subsequent to anti-VEGF treatment, independent of the clinical status. These data were consistent with those of other groups investigating the persistence of neovascular formation in inactive disease over time [17, 18]. In addition to well-defined vessels, nonvascularized halos were more often absent in both active and inactive diseases.…”

Section: Discussionsupporting

confidence: 92%

Relationship between Neovascular Density in Swept Source-Optical Coherence Tomography Angiography and Signs of Activity in Exudative Age-Related Macular Degeneration

Stattin

Forster

Ahmed

et al. 2019

Journal of Ophthalmology

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Purpose. To assess the relationship between signs of activity in exudative neovascular age-related macular degeneration (nAMD) following anti-vascular endothelial growth factor (anti-VEGF) treatment and morphology of choroidal neovascularization (CNV) based on neovascular density as imaged using swept source-optical coherence tomography angiography (SS-OCTA) in a qualitative manner. Methods. A single-cohort retrospective data analysis from one tertiary eye care center. Seventy-seven eyes of 72 patients were included and their charts reviewed which had been started on intravitreal injections with anti-VEGF for nAMD at least one year prior to enrollment. Clinically active disease was evaluated by slit-lamp fundus examination and spectral domain-OCT B-scans. Morphological appearance in SS-OCTA was characterized based on 5 different criteria and subsequently divided into 3 groups: predominantly hyperdense, minimally hyperdense, and hypodense lesions. Results. Fifty-eight eyes (75%) were considered clinically active and 19 eyes (25%) clinically inactive. CNV was depicted in 71 eyes (92%) by SS-OCTA and separated accordingly into predominantly hyperdense (32%), minimally hyperdense (34%), and hypodense lesions (34%). A borderline significant difference in the probability of neovascular activity for predominantly hyperdense lesions compared to hypodense lesions was detected (p=0.05). Conclusions. Hyperdense choroidal neovascularization based on qualitative assessment of flow density showed a significant relation to active disease. Inactivity could not be matched adequately. This study demonstrated the potential usefulness of SS-OCTA for guidance of treatment in age-related macular degeneration.

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Section: Discussionsupporting

confidence: 92%

Relationship between Neovascular Density in Swept Source-Optical Coherence Tomography Angiography and Signs of Activity in Exudative Age-Related Macular Degeneration

Stattin

Forster

Ahmed

et al. 2019

Journal of Ophthalmology

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“… 42 , 43 Nonexudative MNV is characterized by a main vessel trunk with intralesional rarefaction of capillaries and less small vessel branching. 44 , 45 The identification of biomarkers of activity may prove important in predicting which cases of nonexudative MNV will progress to exudation and require anti-VEGF therapy. Exudative MNV may progress and grow at a more rapid rate than nonexudative MNV.…”

Section: Discussionmentioning

confidence: 99%

“…Exudative MNV may progress and grow at a more rapid rate than nonexudative MNV. 46 Also, the perilesional DH may be identified more commonly in eyes with exudative MNV, 18 , 45 because active neovascularization may steal adjacent blood flow from surrounding capillaries. In the present study, eyes with exudative MNV showed a larger mean DH area and greater surrounding CC FD than eyes with nonexudative MNV, although these results were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Choriocapillaris Flow Deficits and Treatment-Naïve Macular Neovascularization Secondary to Age-Related Macular Degeneration

Scharf

Corradetti

Alagorie

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Purpose To evaluate choriocapillaris (CC) flow deficits (FD) in eyes with treatment-naïve macular neovascularization (MNV) and to compare CC FD around exudative versus nonexudative MNV. Methods Treatment-naïve eyes with a diagnosis of either exudative or nonexudative AMD and type 1 MNV were included. Normal control eyes were age-matched to each AMD eye one to one. En face optical coherence tomography angiograms were analyzed for percentage of CC FD (FD%) in two concentric 500 µm rings, ring 1 and ring 2, surrounding the dark halo around MNV. The mean CC FD% in ring 1 and ring 2 was evaluated for each eye. A secondary analysis was similarly carried out to investigate the differences in CC FD% in exudative versus nonexudative treatment-naïve MNV. Results Twenty-three eyes with treatment-naïve MNV were age matched with 23 normal controls. The mean CC FD% was significantly greater in both rings in the MNV versus the normal control group ( P < 0.05) and was significantly greater in the inner ring, closer to the lesion, than the outer ring. The mean FD% was also greater in both rings in the exudative versus the nonexudative MNV group, but this difference did not reach statistical significance. Conclusions The CC FD% was greater in the area surrounding MNV versus age-matched normal controls and in the ring closer to the MNV lesion. Further, CC FD was greater in eyes with exudative versus nonexudative MNV in both rings surrounding the associated dark halo, although this difference was not statistically significant.

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“…They found that CNV lesions do not fully involute after treatment, but rather regress in depth and persist. [87] OCTA has allowed for better visualization of choroidal morphology in AMD and has further corroborated the choroidal attenuation seen on histopathology and SD-OCT.…”

Section: Methodsmentioning

confidence: 83%

“…[82] Wirth et al investigated OCTA characteristics of active and quiescent CNV. [87] In active CNV, a “peripheral halo” was seen around the lesion, suggesting reduced flow to the surrounding capillaries. Inactive lesions were characterized on OCTA by a main trunk vessel with thinning of intralesional capillaries and loss of the peripheral halo.…”

Section: Methodsmentioning

confidence: 99%

Role of the choroid in age-related macular degeneration: A current review

Farazdaghi¹,

Ebrahimi²

2019

J Ophthalmic Vis Res

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Age-related macular degeneration (AMD) is a major cause of vision loss in the developed world and its pathogenesis is a topic of active research. To date, much study has been focused on the role of the retinal pigment epithelium (RPE) and Bruch's membrane (BrM) in AMD pathogenesis, but the role of the choroid has also been investigated. In this review, we focus on recent advancements in research in the role of the choroid in AMD, beginning with an exploration of the histopathologic, cellular and molecular changes that occur in the choroid in AMD and concluding by discussing new choroidal imaging techniques and patterns seen on fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography and optical coherence tomography angiography. Exploring these domains will lead to a better understanding of the factors at play beyond the outer retina in this important disease.

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Optical coherence tomography angiography in age‐related macular degeneration: persistence of vascular network in quiescent choroidal neovascularization

Cited by 11 publications

References 6 publications

Relationship between Neovascular Density in Swept Source-Optical Coherence Tomography Angiography and Signs of Activity in Exudative Age-Related Macular Degeneration

Relationship between Neovascular Density in Swept Source-Optical Coherence Tomography Angiography and Signs of Activity in Exudative Age-Related Macular Degeneration

Choriocapillaris Flow Deficits and Treatment-Naïve Macular Neovascularization Secondary to Age-Related Macular Degeneration

Role of the choroid in age-related macular degeneration: A current review

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