Optical coherence tomography angiography features of choroidal neovascularization secondary to angioid streaks

Abstract

Purpose To characterize the features of choroidal neovascularization (CNV) secondary to angioid streaks (AS) with optical coherence tomography angiography (OCT-A) and to assess its sensitivity in CNV detection in this particular context. Methods Consecutive patients, both with treatment-naïve and recurrent CNV associated with angioid streaks were prospectively analyzed. All patients underwent macular imaging by fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain (SD)-OCT, and OCT-A (AngioVue, Optovue, Optovue Inc., Freemont, CA, USA). OCT-A detection rate of CNV associated to AS was evaluated by two independent observers. We studied the association between OCT-A feature and either exudative or active status using Fisher exact test. Results A total of 32 eyes of 18 consecutive patients were included in the analysis. OCT-A was able to detect CNV associated with angioid streaks in 87.5 % (28/32) eyes. OCT-A phenotypes of CNV were classified into interlacing pattern in 9 eyes, pruned vascular tree pattern in 7 eyes, and combined pattern in 12 eyes (Interuser agreement: 0.871 ± 0.071). CNV were not detectable in 4/32 eyes. There was a statistically significant association between the presence in OCT-A of densely ramified networks with both previous treatment status in the last 6 months (p < 0.001) and with exudative signs on SD-OCT (p = 0.014). Conclusion OCT-A appears as a sensitive tool for detection of CNV secondary to AS. The interlacing pattern was significantly associated with active and exudative features.

Central serous chorioretinopathy and angioid streaks: coincidental?

“…Therefore, considering a potential relation between CSC and angioid streaks, we must focus on their pathophysiology. Recent studies using OCTA highlighted the choriocapillaris rarefaction on OCTA in patients with AS without CNV, interpreting this finding as an eventual atrophy of this vascular layer, associated with the overlying crack-like breaks in a thickened BM [5][6][7]. In particular cases, they described an irregular vascular network in the choriocapillaris in areas affected with AS, presenting a flat elevation of the RPE and hyperreflective accumulations between the BM and RPE on simultaneous structural SD-OCT [5].…”

Irregular vascular network identified with OCT-A in angioid streaks: A probable predictor of active choroidal neovascularization (case series)

“…7 OCT-A findings demonstrated a close correlation between CNV and AS, with neovascular lesions developing at the level of the streak path. 5…”

“…OCT-A showed a good sensitivity detecting CNV in AS, non-invasively. 4,5 It should be integrated into the standard imaging assessment of AS with neovascular complication and monitoring treated CNV evolution.…”

Quantitative Analysis of Choriocapillaris Using Swept-Source Optical Coherence Tomography Angiography in Eyes with Angioid Streaks

“…Angioid streaks may be asymptomatic, but the development of macular neovascularization (MNV), occurring in approximately 42% to 86% of patients during follow-up, and macular atrophy, contributes to severe visual impairment in these patients [3,4]. Moreover, the onset of secondary MNV complicating angioid streaks occurs in the working age population, within the 5th decade according to recent literature [4,5]. While the prevalence of MNV and atrophy is directly proportional to the patients' age, it has recently been shown that in patients with pseudoxanthoma elasticum, eyes with longer angioid streaks (i.e., more extensive calcification of Bruch's membrane) have a higher risk of developing neovascularization or atrophy, and thereby will have a worse visual prognosis [6].…”

“…Multimodal imaging can help identifying foveal or extrafoveal neovascularization associated with angioid streaks. Optical coherence tomography angiography (OCTA) has been shown to be useful not only in the detection of neovascular complications in patients with angioid streaks, but also in evaluating MNV activity [4,5]. Furthermore, OCTA may also help the clinicians gain insight into the very determinants of neovascularization and macular atrophy.…”