Sequential Morphological Changes in the CNV Net after Intravitreal Anti-VEGF Evaluated with OCT Angiography

Abstract

Purpose: To assess and describe sequential morphological changes in the choroidal neovascularization (CNV) net using optical coherence tomography angiography (OCTA) in patients undergoing treatment with intravitreal antivascular endothelial growth factor (VEGF). Methods: Prospective cohort study. OCTA was performed sequentially: before (t0), 1 h (t1), 1 week (t2) and 1 month after the injection (t3), using Avanti RTVue XR equipped with the AngioVue® software (Optovue, Calif., USA). All images were classified by two independent graders. Results: Ten eyes of 10 patients, with a mean age of 72.4 ± 10.5 years, were included. CNV morphology was described as tree-like in 5 eyes, glomerular in 1 and fragmented in 4. A fibrovascular capsule surrounding the CNV net was found in 4 eyes and a feeder trunk was noticed in 6. No changes were observed at t1. Loss of peripheral capillaries, vessel fragmentation and decreased vessel density were evident in 8 eyes at t2. The CNV capillary density and the peripheral anastomosis increased in all of these at t3. Two eyes remained unchanged through the whole length of follow-up. Conclusions: Significant changes in the CNV net can be observable in OCTA at least 1 week after intravitreal anti-VEGF. The safety of frequent examinations may provide a method of gauging treatment effects.

Future clinical applicability of optical coherence tomography angiography

“…Several groups have characterised the anatomy of small vessels and proposed methods to classify choroidal neovascularisation based on these features . OCT‐A has also shown the shrinkage of choroidal neovascularisation after injection with anti‐vascular endothelial growth factor (anti‐VEGF) agents . By examining the sequential morphological changes of small vessels, the OCT‐A may be a powerful tool, particularly in the diagnosis and monitoring of choroidal neovascularisation, and characterising the treatment response to intra‐vitreal anti‐VEGF injections.…”

Advances in Optical Coherence Tomography Angiography

“…26 OCTA can be used to monitor CNV after anti-vascular endothelial growth factor (anti-VEGF) treatment with reduced CNV density and size, vascular rarefication, and loss of smaller or peripheral capillaries after therapy. [27][28][29][30][31] Flow within a vascular network may be apparent on OCTA in a disciform scar from AMD. 32 One study demonstrated alterations in the retinal vasculature in early to intermediate AMD with reduced vessel density in both the superficial and deep inner retinal plexuses and reduced choroidal thickness compared with control.…”

Retinal imaging including optical coherence tomography angiography for detecting active choroidal neovascularization in pseudoxanthoma elasticum

“…On FA it can be difficult to distinguish between a low‐grade leakage caused by CNV activity and staining or window defects unrelated to neovascular activity . OCT‐A, in contrast, visualizes neovascular networks, while phenomena such as leakage or pooling indicative for neovascular activity are not displayed …”

“…6 OCT-A, in contrast, visualizes neovascular networks, while phenomena such as leakage or pooling indicative for neovascular activity are not displayed. 6,[21][22][23][24] In this study, we compared the accuracy of OCT, FA and OCT-A to detect active neovascularization in PXE. Even though all three imaging techniques are employed in daily practice, a systematic comparison of these for more complex fundus pathologies is lacking.…”