Optical Coherence Tomography Angiography Can Categorize Different Subgroups of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Abstract

Purpose: Choroidal neovascularization (CNV) is a common complication of patients affected by age-related macular degeneration, showing a highly variable visual outcome. The main aim of the study was, at baseline, to perform a quantitative optical coherence tomography angiography assessment of CNV secondary to age-related macular degeneration and to assess posttreatment outcomes. Methods: Seventy-eight naïve age-related macular degeneration-related CNV patients (39 men, mean age 78 ± 8 years) were recruited and underwent complete ophthalmologic evaluation and multimodal imaging. Several OCT and optical coherence tomography angiography parameters were collected, including vessel tortuosity and vessel dispersion (VDisp), measured for each segmented CNV. All patients underwent anti–vascular endothelial growth factor PRN treatment. Vessel tortuosity and VDisp values of CNVs were tested at baseline to establish a cutoff able to distinguish clinically different patient subgroups. Results: Mean best-corrected visual acuity was 0.49 ± 0.57 (20/62) at baseline, improving to 0.31 ± 0.29 (20/41) at the 1-year follow-up (P < 0.01), with a mean number of 6.4 ± 1.9 injections. Our cohort included the following CNV types: occult (45 eyes; 58%), classic (14 eyes; 18%), and mixed (19 eyes; 24%). Observing optical coherence tomography angiography parameters, classic, mixed, and occult CNV revealed significantly different values of VDisp, with classic forms showing the highest values and the occult CNVs showing the lowest (P < 0.01); mixed forms displayed intermediate VDisp values. The ROC analysis revealed that a CNV vessel tortuosity cut-off of 8.40, calculated at baseline, enabled two patient subgroups differing significantly in visual outcomes after anti–vascular endothelial growth factor treatment to be distinguished. Conclusion: A baseline quantitative optical coherence tomography angiography-based parameter could provide information regarding both clinical and functional outcomes after anti–vascular endothelial growth factor treatment in age-related macular degeneration-related CNV.

Optical Coherence Tomography Angiography Quantitative Assessment of Macular Neovascularization in Best Vitelliform Macular Dystrophy

“…Distinct quantitative OCTA parameters were adopted in order to analyze the MNV characteristics, including vessel tortuosity (VT) and vessel dispersion (VDisp), which are already employed in assessing other pathological conditions. [15][16][17][18] In short, VT is defined as the ratio of the shortest pathway to the straight-line length 19 and provides information about vascular perfusion. 20,21 VDisp is defined as a measure of the space-filling of a given vascular tree 22 and provides information about the vascular network disorganization.…”

“…23 MNV was extracted from the 3 × 3-mm OCTA reconstruction, corrected to assess the vertical extension of the lesion. 16 The control group consisted of 40 healthy volunteers matched for age, sex, axial length, and refractive error. All of the control subjects underwent an ophthalmologic examination, complete with SD-OCT and OCTA.…”

“… 23 MNV was extracted from the 3 × 3-mm OCTA reconstruction, corrected to assess the vertical extension of the lesion. 16 …”

Vessel Density and Vessel Tortuosity Quantitative Analysis of Arteritic and Non-arteritic Anterior Ischemic Optic Neuropathies: An Optical Coherence Tomography Angiography Study

“…The first was related to the possible artifacts affecting OCTA images [14]. With respect to VT parameter, this represents a novel quantitative parameter which may be interpreted as an indirect measure of the amount of perfusion [13,15]. Although it is based on the proper reconstruction of the vascular network, it is potentially artifact prone.…”

“…Although it is based on the proper reconstruction of the vascular network, it is potentially artifact prone. On the other hand, since we used only high quality images and the calculation of VT strictly depends on the geometrical properties of continuous linear signal retinal capillaries [13,15] with poor or null influence of spurious artifact signal, it may be considered a reliable quantitative measure of the perfusion features of the retinal vascular network. Moreover, although we selected only high-quality images, we cannot exclude the possible influence of optic disc swelling on the detection of blood flow signal.…”