Optical Coherence Tomography Angiography of Inflammatory Choroidal Neovascularization Early Response after Anti-VEGF Treatment

ABSTRACT

Purpose: To describe the optical coherence tomography angiography (OCTA) features of active inflammatory choroidal neovascularization (CNV) and characterize the early responses of anti-vascular endothelial growth factor (VEGF) treatment for inflammatory CNV.

Methods: OCT angiography images of inflammatory CNV were acquired and analyzed using the RTVue XR Avanti with AngioVue at baseline as well as fluorescein angiography and spectral-domain optical coherence tomography (SD-OCT). OCTA scans were sequentially obtained 1 day before treatment, 1 day, 7 days, 14 days, and 30 days after anti-VEGF injection. Changes of the selected area and flow area of CNV on OCTA were measured along with those of the central macular thickness (CMT) on corresponding SD-OCT.

Results: 19 eyes of 18 uveitic patients (mean age: 36.83 ± 10.05 years) presenting with active CNV were included in the prospective case series. The OCTA showed a 100% sensitivity for inflammatory CNV detection in 23 of 23 CNV lesions, revealing prevailing two neovascular phenotypes: vascular loops and intertwined nets. After anti-VEGF injection, as early as the 1-day follow-up, the mean selected area and the mean flow area of inflammatory CNV on OCTA were significantly reduced (both P < .05) while the average CMT on SD-OCT did not change until the 7-day follow-up. OCTA was able to detect the reincrease of capillary density and vessel size predominantly in the second phenotype 14–30 days after anti-VEGF injection.

Conclusions: OCTA not only allows for noninvasive detection of inflammatory CNV with a high sensitivity but also facilitates its sequential observation after anti-VEGF treatment. The treatment outcomes are observable at day 1 post treatment. OCTA may be a useful tool for diagnosing inflammatory CNV and evaluating the early response to anti-VEGF treatment.

KEYWORDS:

• Optical coherence tomography angiography
• inflammatory choroidal neovascularization
• anti-VEGF treatment
• early response
• uveitis

Declaration of interests

The authors declare that they have no competing interests.

Additional information

Funding

This work was supported by grants from the National Natural Science Foundation of China (81700861, 81700862, 81770944, 81800846), Shanghai Hospital Development Center (SHDC12016116) and Science and Technology Commission of Shanghai Municipality (16411953700).