Fluorescein Angiography and Spectral-Domain Optical Coherence Tomography for Monitoring Anti-VEGF Therapy in Myopic Choroidal Neovascularization

Abstract

Aim: To evaluate the agreement between fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) in detecting myopic choroidal neovascularization (CNV) activity during bevacizumab treatment. Methods: Thirty-four patients with subfoveal myopic CNV were prospectively enrolled. FA and SD-OCT were performed at baseline and at all planned monthly visits. After the first injection, additional treatments were administered following detection of fluid on SD-OCT and/or leakage on FA. κ-Analysis was performed to examine the agreement between FA and SD-OCT. Results: At baseline, FA and SD-OCT agreed in 26/34 cases (κ = 0.23); sensitivity and specificity were 77.4 and 66.7%, respectively. Seven eyes presented leakage on FA with no fluid on SD-OCT, 1 case showed intraretinal fluid on SD-OCT and no leakage on FA. At the 1-month examination, specificity and κ-value improved, and 30/34 cases showed complete concordance. At the 3- and 4-month examinations, a discordance was noted in 6 cases. From the 5-month examination on, a correspondence was achieved in at least 30/34 cases and reached a perfect match in 11 sessions. Conclusions: Our study confirms the key role of FA in diagnosing myopic CNV. It seems possible there may be a role for SD-OCT in assisting FA to monitor the myopic CNV activity during anti-vascular endothelial growth factor antibody treatment.

Imaging in myopia: potential biomarkers, current challenges and future developments

“…The diagnosis is confirmed on fundus FA where the lesion demonstrates hyperfluorescence that increases in size and intensity with time, indicating leakage 35. Furthermore, wide-field fundus FA may reveal retinal avascularity in the 360° of the periphery, which is a feature of PM 33.…”

Fluorescein Leakage and Optical Coherence Tomography Features of Choroidal Neovascularization Secondary to Pathologic Myopia

“…Indeed, many characteristics make it awkward to detect activity, including the usually small size of the myopic CNV (mCNV), limited exudative manifestations, and RPE response. [1][2][3][4][5][6][7][8] Fluorescein angiography (FA) still can be considered the gold standard for identification of activity based on dye leakage. Several features of optical coherence tomography (OCT) have been described as indirect signs that may reflect CNV activity, including increased central macular thickness (CMT), intraretinal cysts, intraretinal fluid, interruption of the external limiting membrane (ELM), and subretinal hyperreflective exudation (SHE).…”

“…Several features of optical coherence tomography (OCT) have been described as indirect signs that may reflect CNV activity, including increased central macular thickness (CMT), intraretinal cysts, intraretinal fluid, interruption of the external limiting membrane (ELM), and subretinal hyperreflective exudation (SHE). [7][8][9][10][11] Nevertheless, there is no perfect correspondence between FA leakage and OCT features and, in addition, OCT signs can vary according to mCNV pattern and over follow-up, especially when treated. [4][5][6][7][8][9][10][11][12][13] We compared FA patterns to morphological alterations detectable on spectral-domain optical coherence tomography (SD-OCT) in treatment-naïve subfoveal mCNV and evaluated whether they influence the effects of ranibizumab therapy.…”

Utility of the ‘Fuzzy Area' for Active Myopic Choroidal Neovascularization Detection by Spectral-Domain Optical Coherence Tomography

“…FA and SD-OCT do not seem to have a good agreement in detecting myopic CNV, and FA is still considered the most valuable tool for detecting myopic CNV activity [2,3] . …”