Ophthalmology. Retina · 2019
Detection of Nonexudative Choroidal Neovascularization and Progression to Exudative Choroidal Neovascularization Using OCT Angiography.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Bailey Steven T, Thaware Omkar, Wang Jie, Hagag Ahmed M, Zhang Xinbo, Flaxel Christina J, Lauer Andreas K, Hwang Thomas S, Lin Phoebe, Huang David, Jia Yali
Аннотация
PURPOSE: To detect nonexudative choroidal neovascularization (CNV) in age-related macular degeneration (AMD) with OCT angiography (OCTA) and determine the risk of exudative CNV developing compared with eyes without nonexudative CNV.
DESIGN: Prospective, longitudinal, observational study.
PARTICIPANTS: Consecutive patients with drusen and pigmentary changes in the study eye and exudative neovascular AMD in the fellow eye.
METHODS: In this prospective observational study, participants underwent spectral-domain OCTA (AngioVue; Optovue, Inc, Fremont, CA), clinical examination, and structural OCT at baseline and 6-month intervals for 2 years. OCT angiography images were exported for custom processing to remove projection artifact and calculate CNV vessel area.
MAIN OUTCOME MEASURES: Rate of developing exudation in eyes with and without nonexudative CNV as detected by OCTA on regular follow-up.
RESULTS: Sixty-three study participants were followed up every 6 months and 48 completed the 2-year study. Mean age was 78 years and 60.3% were female. On the baseline visit, 5 eyes (7.9%) were found to have nonexudative CNV by OCTA, and 3 of them demonstrated exudation. Of 58 eyes with a normal OCTA on baseline visit, 5 eyes developed nonexudative CNV during a follow-up visit. All 5 of these nonexudative CNV went on to develop exudation in subsequent visits. Overall, 8 of the 10 eyes with nonexudative CNV developed exudation with a mean time of 8 months and mean CNV area growth rate of 20% per month (P = 0.014, exponential model). Initiation of antiangiogenic treatment halted their growth. In comparison, exudation occurred in only 6 of the 53 eyes (11%) that lacked a precursor nonexudative CNV. Cox proportional hazard analysis showed that having nonexudative CNV detected was associated with an 18.1-fold increase in the rate of exudation subsequently developing (P < 0.0001).
CONCLUSIONS: Nonexudative CNV frequently is detected by OCTA in the fellow eyes of those with exudative CNV. These lesions carry a high risk of exudation developing within the first year after detection and could benefit from close monitoring. The high risk of progression may justify prophylactic treatment; further studies are needed.
DESIGN: Prospective, longitudinal, observational study.
PARTICIPANTS: Consecutive patients with drusen and pigmentary changes in the study eye and exudative neovascular AMD in the fellow eye.
METHODS: In this prospective observational study, participants underwent spectral-domain OCTA (AngioVue; Optovue, Inc, Fremont, CA), clinical examination, and structural OCT at baseline and 6-month intervals for 2 years. OCT angiography images were exported for custom processing to remove projection artifact and calculate CNV vessel area.
MAIN OUTCOME MEASURES: Rate of developing exudation in eyes with and without nonexudative CNV as detected by OCTA on regular follow-up.
RESULTS: Sixty-three study participants were followed up every 6 months and 48 completed the 2-year study. Mean age was 78 years and 60.3% were female. On the baseline visit, 5 eyes (7.9%) were found to have nonexudative CNV by OCTA, and 3 of them demonstrated exudation. Of 58 eyes with a normal OCTA on baseline visit, 5 eyes developed nonexudative CNV during a follow-up visit. All 5 of these nonexudative CNV went on to develop exudation in subsequent visits. Overall, 8 of the 10 eyes with nonexudative CNV developed exudation with a mean time of 8 months and mean CNV area growth rate of 20% per month (P = 0.014, exponential model). Initiation of antiangiogenic treatment halted their growth. In comparison, exudation occurred in only 6 of the 53 eyes (11%) that lacked a precursor nonexudative CNV. Cox proportional hazard analysis showed that having nonexudative CNV detected was associated with an 18.1-fold increase in the rate of exudation subsequently developing (P < 0.0001).
CONCLUSIONS: Nonexudative CNV frequently is detected by OCTA in the fellow eyes of those with exudative CNV. These lesions carry a high risk of exudation developing within the first year after detection and could benefit from close monitoring. The high risk of progression may justify prophylactic treatment; further studies are needed.
Предметные рубрики MeSH
AgedAged, 80 and overAngiogenesis InhibitorsChoroidal NeovascularizationDisease ProgressionExudates and TransudatesFemaleFluorescein AngiographyFollow-Up StudiesHumansIntravitreal InjectionsLongitudinal StudiesMaleProportional Hazards ModelsProspective StudiesRetinal DrusenTomography, Optical CoherenceVascular Endothelial Growth Factor AWet Macular Degeneration