Optical Coherence Tomography Angiography of Time Course of Choroidal Neovascularization in Response to Anti-Angiogenic Treatment

Abstract

Purpose To use optical coherence tomography (OCT) angiography to monitor the short-term blood flow changes in choroidal neovascularization (CNV) in response to treatment. Participants One patient with exudative age-related macular degeneration (AMD) Methods In this retrospective report, a case of CNV was followed closely with OCT angiography over 3 cycles of anti-angiogenic treatment. Outer retinal flow index, CNV flow area and central macular retinal thickness were measured. Results Quantitative measurements of CNV flow area and flow index showed rapid shutdown of flow over the initial 2 week, followed by re-appearance of CNV channel by the 4th week, preceding fluid re-accumulation at 6 weeks. Conclusions Frequent OCT angiography reveals a previously unknown pattern of rapid shutdown and re-appearance of CNV channels within treatment cycles. OCT angiographic changes precede fluid re-accumulation and could be useful as leading indicators of CNV activity that could guide treatment timing. Further studies using OCT angiography in short intervals between anti-angiogenic treatments are needed.

Projection-resolved optical coherence tomographic angiography

“…The PR algorithm, together with the Saliency algorithm, also more cleanly completely separated CNV flow signal from projected clutter. This ability may improve the early detection of CNV [37] and the management anti-VEGF therapy in neovascular AMD [38], another leading cause of blindness [19].…”

Optical coherence tomography angiography in wet age-related macular degeneration (AMD)

“…Furthermore, the non-invasive nature of the technique allows comprehensive lesion monitoring after treatment with anti-VEGF compounds. Quantitative measurements of the CNV flow area and flow index reported by Huang et al (11) showed a rapid shutdown of flow over the initial 2 weeks after treatment with anti-VEGF, followed by reappearance of the CNV channel by the fourth week and fluid reaccumulation at 6 weeks. As demonstrated by Lumbroso et al (12) and Marques et al (10), sequential examinations can shadow morphological changes in the neovascular network, closely tracking the timings of vascular network remodeling in patients undergoing treatment.…”

Reflectance-based projection-resolved optical coherence tomography angiography [Invited]

“…OCTA derived quantitative metrics are important for assessing the effectiveness of anti-angiogenic therapy and monitoring recurrent growth of CNV [5,6,[13][14][15]. The vascular integrity is critical in accurately detecting CNV.…”