Spatial Distribution of Choriocapillaris Impairment in Eyes With Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Moult, Eric M.; Alibhai, A. Yasin; Rebhun, Carl B; Lee, ByungKun; Ploner, Stefan B.; Schottenhamml, Julia; Husvogt, Lennart; Baumal, Caroline R.; Witkin, André J.; Maier, Andreas; Duker, Jay S.; Rosenfeld, Phillip J.; Waheed, Nadia K.; Fujimoto, James G.

doi:10.1097/iae.0000000000002556

Cited by 38 publications

(31 citation statements)

References 51 publications

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“…Recent advances in OCTA and image analysis techniques 36 have demonstrated that CC impairment is greatest in the region surrounding MNV, but these studies were small and descriptive. 1 , 19 , 33 , 37 Recent work by Treister et al 16 best parallels the current analysis described in this article. The Treister study included FD% in the DH itself (defined as a 200 µm ring around the MNV) 16 and noted a greater CC FD% in the halo, as would be expected.…”

Section: Discussionsupporting

confidence: 65%

“…The process of macular neovascularization (MNV) secondary to AMD can be associated with significant disruption of the choriocapillaris (CC) in the area surrounding the MNV 1 , 2 and CC impairment may be the initial insult that drives MNV formation, suggesting that neovascular AMD may be a vascular disease with secondary RPE and photoreceptor degeneration owing to CC damage. 1 , 3 , 4 Recent optical coherence tomography angiography (OCTA) studies have shown that eyes with geographic atrophy exhibit greater CC flow deficits (FD) versus normal eyes and versus eyes with neovascular AMD and that CC impairment may predict the progression of geographic atrophy (GA). 5 – 7 …”

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confidence: 99%

“… 14 , 15 Several studies have investigated FD of the CC in the perilesional low-flow dark halo (DH) surrounding MNV using en face OCTA analysis. 1 , 16 – 19 …”

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confidence: 99%

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Choriocapillaris Flow Deficits and Treatment-Naïve Macular Neovascularization Secondary to Age-Related Macular Degeneration

Scharf

Corradetti

Alagorie

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Purpose To evaluate choriocapillaris (CC) flow deficits (FD) in eyes with treatment-naïve macular neovascularization (MNV) and to compare CC FD around exudative versus nonexudative MNV. Methods Treatment-naïve eyes with a diagnosis of either exudative or nonexudative AMD and type 1 MNV were included. Normal control eyes were age-matched to each AMD eye one to one. En face optical coherence tomography angiograms were analyzed for percentage of CC FD (FD%) in two concentric 500 µm rings, ring 1 and ring 2, surrounding the dark halo around MNV. The mean CC FD% in ring 1 and ring 2 was evaluated for each eye. A secondary analysis was similarly carried out to investigate the differences in CC FD% in exudative versus nonexudative treatment-naïve MNV. Results Twenty-three eyes with treatment-naïve MNV were age matched with 23 normal controls. The mean CC FD% was significantly greater in both rings in the MNV versus the normal control group ( P < 0.05) and was significantly greater in the inner ring, closer to the lesion, than the outer ring. The mean FD% was also greater in both rings in the exudative versus the nonexudative MNV group, but this difference did not reach statistical significance. Conclusions The CC FD% was greater in the area surrounding MNV versus age-matched normal controls and in the ring closer to the MNV lesion. Further, CC FD was greater in eyes with exudative versus nonexudative MNV in both rings surrounding the associated dark halo, although this difference was not statistically significant.

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Section: Discussionsupporting

confidence: 65%

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confidence: 99%

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Choriocapillaris Flow Deficits and Treatment-Naïve Macular Neovascularization Secondary to Age-Related Macular Degeneration

Scharf

Corradetti

Alagorie

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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“…This dark halo may in fact be a marker of activity of the neovascularization [ 78 , 98 ]. The choriocapillaris immediately surrounding MNV shows higher flow deficits than other areas of the macula [ 109 , 110 , 111 ]. The association holds true even when analyzing only the choriocapillaris immediately outside of the perilesional dark halo in treatment-naïve eyes ( Figure 4 ) [ 44 ].…”

Section: Octa Of the Choriocapillaris In Neovascular Amdmentioning

confidence: 99%

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Scharf

Corradetti

Corvi

et al. 2021

JCM

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The advent of optical coherence tomography angiography (OCTA) has allowed for remarkable advancements in our understanding of the role of the choriocapillaris in age-related macular degeneration (AMD). As a relatively new imaging modality, techniques to analyze and quantify choriocapillaris images are still evolving. Quantification of the choriocapillaris requires careful consideration of many factors, including the type of OCTA device, segmentation of the choriocapillaris slab, image processing techniques, and thresholding method. OCTA imaging shows that the choriocapillaris is impaired in intermediate non-neovascular AMD, and the severity of impairment may predict the advancement of disease. In advanced atrophic AMD, the choriocapillaris is severely impaired underneath the area of geographic atrophy, and the level of impairment surrounding the lesion predicts the rate of atrophy enlargement. Macular neovascularization can be readily identified and classified using OCTA, but it is still unclear if neovascularization features with OCTA can predict the lesion’s level of activity. The choriocapillaris surrounding macular neovascularization is impaired while the more peripheral choriocapillaris is spared, implying that choriocapillaris disruption may drive neovascularization growth. With continued innovation in OCTA image acquisition and analysis methods, advancement in clinical applications and pathophysiologic discoveries in AMD are set to follow.

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“…Studies have shown that levotinib is effective in the treatment of anti-angiogenesis. It can inhibit angiogenesis by inhibiting the activation of VEGF2R, suggesting that levotinib may also be effective in the treatment of fundus angiogenesis-related diseases ( Farinha et al, 2020 , Moult et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Establishing a mouse model of choroidal neovascularization to study the therapeutic effect of levotinib and its mechanism

Xin

Zhu

et al. 2020

Saudi Journal of Biological Sciences

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Objective To study the therapeutic effect and mechanism of levotinib on choroidal neovascularization (CNV) in mice. Methods 45 healthy C57BL/6 mice were selected and randomly divided into three groups: control group (group A), model group (group B) and levotinib group (group C). The model of CNV in mice was established. The fluorescence leakage of choroidal lesions in mice was observed by fundus fluorescein angiography. The morphological changes of retinal vessels in mice were observed by retinal slice preparation, the pathological changes of eyeball tissues in mice were observed by hematoxylin-eosin (HE) staining, the expression of vascular endothelial growth factor (VEGF) in mice retina was detected by real-time quantitative fluorescence PCR, and the protein expression of VEGF in mice retina was detected by Western blotting. Result On the 7th, 14th and 21st day after modeling, compared with group B, the fluorescence leakage area of group C mice was significantly reduced, and the difference was statistically significant (P < 0.05). The morphology of retinal vessels in group A was normal. In group B, the retinal vessels showed large areas of ischemia without perfusion and abundant neovascularization clusters and capillaries. Compared with group B, the morphology of retinal vessels in group C was significantly improved. Group A mice had normal eyeball structure, group B mice had visible spindle-like damage to the inner and outer retina, while group C mice had significantly less spindle-like damage than group B. Compared with group A, group B mice had significantly higher expression of retinal VEGF and the difference was statistically significant (P < 0.05), but compared with group B mice, the expression of VEGF in the retina of mice in group C was significantly decreased, and the difference was statistically significant (P < 0.05). Compared with group A, the expression of VEGF in retina of group B mice was significantly increased, and the difference was statistically significant (P < 0.05). Compared with group B, the expression of VEGF in retina of group C mice was significantly decreased, and the difference was statistically significant (P < 0.05). Conclusion Levatinib has obvious therapeutic effect on CNV, which may be achieved by inhibiting the high expression of VEGF in CNV.

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Spatial Distribution of Choriocapillaris Impairment in Eyes With Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Cited by 38 publications

References 51 publications

Choriocapillaris Flow Deficits and Treatment-Naïve Macular Neovascularization Secondary to Age-Related Macular Degeneration

Choriocapillaris Flow Deficits and Treatment-Naïve Macular Neovascularization Secondary to Age-Related Macular Degeneration

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Establishing a mouse model of choroidal neovascularization to study the therapeutic effect of levotinib and its mechanism

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