Retinal Vascularization Analysis on Optical Coherence Tomography Angiography before and after Intraretinal or Subretinal Fluid Resorption in Exudative Age-Related Macular Degeneration: A Pilot Study

Abstract

The aim was to analyze the variations in macular vascularization on optical coherence tomography angiography (OCTA) according to the presence of intraretinal fluid (IRF) induced by exudative age-related macular degeneration (AMD). We included exudative AMD patients with IRF and/or subretinal fluid (SRF) and age-matched control eyes. All patients underwent a macular 6 × 6 mm swept-source OCTA. The mean perfusion density (MPD) and mean vascular density (MVD) were calculated in the superficial (SCP) and the deep (DCP) capillary plexus at two timepoints: during an episode of exudation (T0) and after its total resorption (T1). A total of 22 eyes in the IRF ± SRF group, 11 eyes in the SRF group and 11 eyes in the healthy group were analyzed. At T0, the IRF ± SRF group showed significantly lower MPD and MVD than healthy eyes in the SCP (p < 0.001) and DCP (p < 0.001). At T1, MPD and MVD significantly increased from T0 in the SCP (p = 0.027 and p = 0.0093) and DCP (p = 0.013 and p = 0.046) but remained statistically lower than in the healthy eyes. For the SRF group, only the DCP showed significantly lower MPD (p = 0.012) and MVD (p = 0.046) in comparison to the healthy eyes at T0. The present study shows that retinal vascular changes do occur in the case of exudative AMD.

Relevance of Visual Acuity Measurement for Therapeutic Decisions in Diabetic Macular Edema

“…It could therefore be of interest to determine which test would predict long-term maintenance/improvement of visual acuity. In this case, biomarkers on OCTA have been described in AMD [ 17 ] and also for DME [ 18 ]. However, currently, we do not have guidelines that use these new features in our clinical practice.…”

Age-Related Macular Degeneration: New Insights in Diagnosis, Treatment, and Prevention

“…Secondly, it can show modifications to the normal macular vascularization resulting from the disease itself or the aging of the retinal and choroidal tissue [4]. As demonstrated in diabetic macular edema, it appears that intraretinal fluid, which is associated with poorer visual prognosis in AMD, is related to worse vascular reperfusion when treated, in comparison to subretinal fluid [5]. Moreover, deep exploration inside the macular vascularization, at the choriocapillaris level, has demonstrated that the fellow-eyes in cases of unilateral neovascular AMD also showed vascular abnormalities such as nonexudative AMD (known as quiescent neovascularization, sometimes seen on invasive indocyanine green angiography), or choriocapillaris flow deficit, as already described in cases of high blood pressure or diabetes [4,6,7].…”