Received: 24 November 2021; Published on-line: 30 April 2022
Optical coherence tomography angiography as an indicator of the efficacy of treatment for choroidal neovascularization
F. A. Bakhritdinova 1, Z. R. Maksudova 2, N. A. Usmanova 2; F. M. Urmanova 1
1 Tashkent Medical Academy, Tashkent (Uzbekistan)
2 Innovative Clinic DMC; Tashkent (Uzbekistan)
TO CITE THIS ARTICLE: Bakhritdinova FA, Maksudova ZR, Usmanova NA, Urmanova FM. Optical coherence tomography angiography as an indicator of the efficacy of treatment for choroidal neovascularization. J.ophthalmol.(Ukraine).2022;2:15-20. http://doi.org/10.31288/oftalmolzh202221520
Background: Choroidal neovascularization (CNV) occurs in as much as 11.3% of patients with pathological myopia, and is a major cause of visual disability associated with irreversible loss of central vision. The advent of optical coherence tomography angiography (OCTA) has opened up new opportunities for objective documentation and real-time qualitative and quantitative evaluation of CNV in the course of therapy.
Purpose: To assess the efficacy of anti-vascular epithelium growth factor (VEGF) therapy with ranibizumab in CNV associated with pathological myopia using OCTA.
Material and Methods: Thirty seven anti-VEGF-treatment naive patients (37 eyes) with myopic CNV were involved in the study. All study participants received an intravitreal ranibizumab injection (in accordance with the manufacturer’s recommendations) followed by as needed (PRN) retreatment.
Results: Complete subretinal fluid resorption with adherence of the neurosensory retina was observed in all the 37 eyes; the mean number of intravitreal ranibizumab injections required was 4.56 ± 0.1. Over the 18-month follow up period, best-corrected visual acuity (BCVA) improved from 0.12 ± 0.03 to 0.42 ± 0.04 in 27 eyes (72.97%). OCTA patterns of CNV activity tended to fade, with the characteristic presence of isolated long filamentous vessels having a “dead tree” appearance.
Conclusion: Application of OCTA, an information-rich modality, in pathological myopia, facilitates a personalized approach to determining the need for anti-VEGF therapy and selecting the mode of administration of anti-VEGF agents based on the CNV activity.
Keywords: choroidal neovascularization, anti-VEGF therapy, optical coherence tomography angiography, pathological myopia
1.Chan WM, Ohji M, Lai TYY, Tano Y, Lam DSC. Choroidal neovascularization in pathological myopia: an update in management. Br J Ophth. 2005 Nov;89(11):1522-8.
2.Min CH , Al-Qattan HM, Lee JY, Kim J-G. Macular Microvasculature in High Myopia without Pathologic Changes: An Optical Coherence Tomography Angiography Study. Korean J Ophthalmol. 2020 Apr; 34(2): 106–12.
3.Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study. Ophthalmology. 2010 Aug;117(8):1595-611, 1611.e1-4.
4.Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016 May;123(5):1036-42.
5.Tufail A, Narendran N, Patel PJ, et al. Ranibizumab in myopic choroidal neovascularization: the 12 month results from the REPAIR study. Ophthalmology. 2013 Sep;120(9):1944-5.e1.
6.Wolf S, Balciuniene VJ, Laganovska G, et al. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia. Ophthalmology. 2014 Mar;121(3):682-92.e2.
7.Neelam K, Cheung CM, Ohno-Matsui K, et al. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res. 2012 Sep;31(5):495-525.
8.Raecker ME, Park D.-W, Lauer AK. Diagnosis and treatment of CNV in myopic macular degeneration. Eye Net Magazine. 2015: 35–7.
9.Wong TY, Ohno-Matsui K, Leveziel N, et al. Myopic choroidal neovascularization: current concepts and update on clinical management. Br J Ophthalmol. 2015 Mar;99(3):289-96.
10.Ng WY, Ting DS, Agrawal R, et al. Choroidal structural changes in myopic choroidal neovascularization after treatment with Antivascular endothelial growth factor over 1 year. Invest Ophthalmol Vis Sci. 2016 Sep 1;57(11):4933-9.
11.Wang Y, Hu Z, Zhu T, et al. Optical Coherence Tomography Angiography-Based Quantitative Assessment of Morphologic Changes in Active Myopic Choroidal Neovascularization During Anti-vascular Endothelial Growth Factor Therapy. Front Med (Lausanne). 2021 May 7;8:657772.
12.Venediktova OA, Saksonov SG, Suk SA. [Diagnostic value of optical coherence tomography and fluorescein angiography in the evaluation of the dynamics of regression of classical subretinal neovascular membranes at high-complicated myopia after combined use of ranibizumab and transpupillary thermotherapy]. Ukrainian Scientific Medical Youth Journal. 2012; 2:53 55. Russian.
13.Coscas G, Lupidi M, Coscas F, Français C, Cagini C, Souied EH. Optical coherence tomography angiography during follow-up: qualitative and quantitative analysis of mixed type I and II choroidal neovascularization after vascular endothelial growth factor trap therapy. Оphthalmic Res. 2015;54(2):57-63.
14.Coscas GJ, Lupidi M, Coscas F, Cagini F, Souied EH. OCTA versus traditional multimodal imaging in assessing the activity of exudative AMD. A new diagnostic challenge. Retina. 2015 Nov;35(11):2219-28.
Conflict of Interest. The authors declare that there are no conflicts of interest that would affect their opinion of the subject matter or materials discussed in this manuscript.