Klin Monbl Augenheilkd 2020; 237(11): 1312-1319
DOI: 10.1055/a-1214-6521
Klinische Studie

Analysis of the Vascular Morphology of the Fibrotic Choroidal Neovascularization in Neovascular Age-Related Macular Degeneration Using Optical Coherence Tomography Angiography

Article in several languages: English | deutsch
1  Retinologie, Augenzentrum am St. Franziskus-Hospital Münster
,
Martin Ziegler
1  Retinologie, Augenzentrum am St. Franziskus-Hospital Münster
,
1  Retinologie, Augenzentrum am St. Franziskus-Hospital Münster
,
Henrik Faatz
1  Retinologie, Augenzentrum am St. Franziskus-Hospital Münster
,
Marie-Louise Gunnemann
1  Retinologie, Augenzentrum am St. Franziskus-Hospital Münster
,
Matthias Gutfleisch
1  Retinologie, Augenzentrum am St. Franziskus-Hospital Münster
,
Georg Spital
1  Retinologie, Augenzentrum am St. Franziskus-Hospital Münster
,
Albrecht Peter Lommatzsch
1  Retinologie, Augenzentrum am St. Franziskus-Hospital Münster
2  Klinik für Augenheilkunde, Universitätsklinikum Essen
3  Achim-Wessing-Institut für Ophthalmologische Diagnostik, Universitätsklinikum Essen
,
Daniel Pauleikhoff
1  Retinologie, Augenzentrum am St. Franziskus-Hospital Münster
2  Klinik für Augenheilkunde, Universitätsklinikum Essen
3  Achim-Wessing-Institut für Ophthalmologische Diagnostik, Universitätsklinikum Essen
› Author Affiliations

Abstract

Purpose Choroidal neovascularization (CNV) in neovascular age-related macular degeneration (nAMD) undergoing anti-VEGF therapy transforms into a fibrotic lesion. This fibrovascular transformation is associated with a great variety of functional and morphological effects. The aim of this study was to investigate the vascular morphology of fibrotic CNV, to compare it with its surrounding tissue and to identify phenotypes using optical coherence tomography angiography (OCTA).

Methods In 18 eyes with fibrotic CNV in nAMD spectral domain OCT (SD-OCT) and OCTA were performed. The automated segmentation lines were manually adjusted. A slab from 60 µm beneath Bruchʼs membrane to the inner edge of the subretinal hyperreflective material was applied. Quantitative analysis of the vascular morphology was performed using skeletonized OCTA images.

Results Compared to the perilesional rim, the number of segments per area was significantly lower (234.75 ± 25.68 vs. 255.30 ± 20.34 1/mm2, p = 0.0003) within the fibrovascular lesion. Two phenotypes could be identified within the lesion. The phenotypic traits of cluster 1 were few, long and thick vascular segments; Cluster 2 was characterized by many, short and thin vascular segments (number of segments per area: 219.4 ± 18.8 vs. 258.8 ± 13.2 1/mm2, p = 0.00009, segment length: 49.6 ± 2.7 vs. 45.0 ± 1.3 µm, p = 0.0002, vascular caliber: 26.6 ± 1.2 vs. 23.5 ± 1.8 µm, p = 0.003). The clusters did not differ significantly regarding visual acuity (0.52 ± 0.44 vs. 0.54 ± 0.18 logMAR, p = 0.25), differentiability of subretinal (OR = 3.43, CI = [0.30, 39.64], p = 0.6) and intraretinal fluid (OR = 5.34, CI = [0.48, 89.85], p = 0.14). Less normalized ellipsoid zone (EZ) loss could be observed in cluster 1 (131.0 ± 161.3 vs. 892.4 ± 955.6 1/m, p = 0.006).

Conclusion In this study the vascular morphology of fibrotic CNV was analyzed using OCTA. Differences between the lesion and a perilesional rim could be detected. Two phenotypes within the fibrovascular lesion were identified. These morphological clusters could indicate different patterns of fibrovascular transformation of the CNV under long-term anti-VEGF therapy and be useful identifying possible predictive biomarkers in future studies.



Publication History

Received: 09 April 2020

Accepted: 08 June 2020

Publication Date:
31 August 2020 (online)

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