Optical Coherence Tomography Angiography Features of Subretinal Fibrosis After Myopic Neovascularization

Abstract

Purpose: To describe the optical coherence tomography (OCT) angiography features of subretinal fibrosis in eyes with myopic choroidal neovascularization after natural evolution or secondary to intravitreal anti–vascular endothelial growth factor therapy. Methods: Retrospective observational case series. All eyes underwent a multimodal imaging examination including fluorescein angiography, spectral domain OCT, OCT angiography, and en face OCT. Results: Twenty-five eyes of 25 patients with mean age of 56.4 ± 14.9 were included in the study. Subretinal fibrosis was diagnosed at mean 30 (range 6–116) months before inclusion. Within the subretinal fibrosis, an abnormal vascular network was observed in 20/25 (80%) eyes, located typically in the outer retina (18/20, 90%) or the choriocapillaris (14/20, 70%) segmentation. The most prevalent patterns were “round tangle” and “tapered tangle.” On en face OCT, the subretinal fibrosis was evidenced in 24/25 (96%) eyes, most prevalently in the outer retina (21/25, 84%) and in the choriocapillaris (18/25, 72%), where main feature was white-hyperreflective (20/21, 95%) and dark-hyporeflective (17/18, 94%) appearance, respectively. The presence of subretinal fibrosis on en face OCT was positively correlated with the presence of abnormal vascular network on OCT angiography in 61% of the cases (P = 0.005). Conclusion: Subretinal fibrosis secondary to myopic choroidal neovascularization frequently contains blood flow within a persistent abnormal vascular network as assessed by OCT angiography.

Comment on: Diagnostic algorithm utilising multimodal imaging including optical coherence tomography angiography for the detection of myopic choroidal neovascularization

“…Thus, non-invasive and fast SD-OCT to assess lesion characteristics becomes crucial, but in some eyes tomographic signs of activities, including the presence of hyperreflective material with intraretinal or subretinal fluid, intraretinal fuzzy area, and retinal pigment epithelium elevation, may be difficult to detect or dependent on the examiners' interpretation and experience. Similarly, presence of ellipsoid zone and external limiting membrane interruption as signs of activity, as reported by some authors [2,3], require additional validation and consensus since visual improvement and mCNV inactivity may occur after intravitreal treatment despite ellipsoid zone and external limiting membrane reconstitution within the lesion [4]. Occasionally, it is challenging to distinguish fibrosis from active mCNV on SD-OCT.…”