Optical Coherence Tomography Angiography to Distinguish Changes of Choroidal Neovascularization after Anti-VEGF Therapy: Monthly Loading Dose versus Pro Re Nata Regimen

Abstract

Purpose To compare the qualitative and quantitative choroidal neovascularization (CNV) changes after antivascular endothelial growth factor (anti-VEGF) therapy in treatment-naïve and treated eyes with age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA). Methods Consecutive patients with neovascular AMD underwent multimodal imaging, including OCTA (AngioPlex, CIRRUS HD-OCT model 5000; Carl Zeiss Meditec, Inc., Dublin, OH) at baseline and at three monthly follow-up visits. Treatment-naive AMD patients undergoing anti-VEGF loading phase were included in group A, while treated patients were included in group B. Qualitative and quantitative OCTA analyses were performed on outer retina to choriocapillaris (ORCC) slab. CNV size was measured using a free image analysis software (ImageJ, open-source imaging processing software, 2.0.0). Results Twenty-five eyes of 25 patients were enrolled in our study (mean age 78.32 ± 6.8 years): 13 treatment-naïve eyes in group A and 12 treated eyes in group B. While qualitative analysis revealed no significant differences from baseline to follow-up in the two groups, quantitative analysis showed in group A a significant decrease in lesion area (P = 0.023); in group B, no significant change in the lesion area was observed during anti-VEGF therapy (P = 0.93). Conclusion Treatment-naïve and treated eyes with CNV secondary to neovascular AMD respond differently to anti-VEGF therapy. This should be taken into account when using OCTA for CNV follow-up or planning therapeutic strategies.

Features and Diagnostic Accuracy of Optical Coherence Tomography Angiography in Neovascular Age-related Macular Degeneration

“…We also found that the area of CNV in enface image reduced with anti-VEGF therapy in nine eyes followed up on OCTA monthly for 3-4 months (average 3.5 months). The response to anti-VEGF has been observed in other studies [13,[25][26][27]. OCTA also identified four eyes with classic CNV on FFA as RAP type 3, observed as a small, round, well-defined hyperreflective microvascular tuft at the outer capillary plexus level [28].…”

Characterisation of vascular changes in different stages of Stargardt disease using double swept-source optical coherence tomography angiography

“…To the best of our knowledge, the ORCC layer has not been examined in STGD so far. Hitherto this layer has mainly been used to visualise features of type I and type II choroidal neovascularization (CNV) 14 15. The ORCC slab includes parts of the outer retina, the RPE and, to a small degree, the CC, and reveals a homogeneous architecture in healthy individuals.…”

Time course of swept-source optical coherence tomography angiography findings after photodynamic therapy and aflibercept in eyes with age-related macular degeneration

“…SS-OCT is a useful noninvasive technology for monitoring the morphology of AMD after PDT and IVA treatment. However, because all cases had a history of anti-VEGF therapy and/or PDT, as reported by Miere et al, 24 the results may differ in treatment-naïve cases. Longer studies with more patients are necessary.…”