To describe the qualitative and quantitative changes in choroidal neovascularization (CNV) flow pattern after anti–vascular endothelial growth factor therapy, by optical coherence tomography angiography (OCTA).
Consecutive patients with neovascular age-related macular degeneration underwent multimodal imaging, including OCTA at initial examination and at last visit. High-flow networks in the choriocapillaris segmentation of OCTA were qualitatively and quantitatively analyzed at baseline and at follow-up, to characterize vascular flow changes after anti–vascular endothelial growth factor treatment and to correlate these changes with final exudation signs on spectral domain optical coherence tomography.
Seventeen eyes were included. Mean follow-up was of 11.7 ± 3.3 months. Baseline images showed six medusa pattern (35.3%), four seafan pattern (23.5%), and seven indistinct network patterns (41.2%). Mean CNV area at baseline was 1.58 ± 1.72 mm2. Final OCTA images revealed a decrease in CNV total area of 21.6%. In 6/17 eyes, the baseline neovascular pattern was unchanged; these cases were associated with exudation at the final spectral domain optical coherence tomography examination (P = 0.034) and a decrease in CNV area of 34.1%. Conversely, in 11/17 eyes (64.7%), the initial pattern had changed to a pruned vascular tree pattern, with variable exudative status on spectral domain optical coherence tomography at the final visit and a decrease in total CNV area of 0.07%.
The vascular flow remodeling induced by recurrent anti–vascular endothelial growth factor treatment can be assessed by OCTA. Optical coherence tomography angiography may help to accurately evaluate treatment response and to recognize patterns usually associated with recurrent exudative activity.
Follow-up of choroidal neovascularization in the context of neovascular age-related macular degeneration, using optical coherence tomography angiography, reveals either a constant flow pattern in 6/17 eyes (always associated with persistent exudation) or vascular remodeling, characterized by maturation of the neovascular membrane in 11/17 eyes, with variable exudative status.
*Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, Créteil, France; and
†Clinical Research Center, GRC Macula, Centre Hospitalier Intercommunal de Créteil, France.
Reprint requests: Eric H. Souied, MD, PhD, Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 40 Avenue de Verdun, Créteil 94000, France; e-mail: firstname.lastname@example.org
S. Y. Cohen consultant for Alcon (Hünenberg, Switzerland), Allergan Inc (Irvine, CA), Novartis (Basel, Switzerland), Bayer Shering-Pharma (Berlin, Germany), Farmila-Thea (Clermont-Ferrand, France), Roche (San Francisco, CA). O. Semoun consultant for Novartis (Basel, Switzerland), Bayer Shering-Pharma (Berlin, Germany), Allergan Inc (Irvine, CA), Optovue (Freemont, CA). E. H. Souied consultant for consultant for Novartis (Basel, Switzerland), Bayer Shering-Pharma (Berlin, Germany), Allergan Inc (Irvine, CA), Farmila-Thea (Clermont-Ferrand, France). The remaining authors have no financial/conflicting interests to disclose.