scholarly journals Asymmetric response to ranibizumab in mixed choroidal neovascularization in a neovascular age-related macular degeneration diagnosed on OCT angiography – case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Martin Pencak ◽  
Miroslav Veith
Keyword(s):  
Optical Coherence Tomography ◽  
Case Report ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Intravitreal Ranibizumab ◽  
Asymmetric Response ◽  
Age Related

Abstract Background To present a case report of a patient with a mixed choroidal neovascular membrane (CNV) with an asymmetric response to ranibizumab diagnosed on optical coherence tomography angiography (OCTa). Case presentation A 61-year-old male was referred to our department in September 2017 due to decreased vision in his left eye. Best-corrected visual acuity (BCVA) was 43 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in the left eye. Macular edema was present in the left eye, and a mixed CNV was identified on the OCTa. Therapy with intravitreal ranibizumab was commenced. After 5 ranibizumab injections, the BCVA was 42 ETDRS letters, and considerable intraretinal edema was still present. OCTa showed a resolution of the type 2 lesion of the mixed CNV; however, the type 1 lesion had continued to grow. The patient was then switched to intravitreal aflibercept. After 3 monthly aflibercept injections, the BCVA improved to 53 ETDRS letters, and a reduction of the edema was observed on the optical coherence tomography (OCT). OCTa showed a decrease in both the area and vessel density in the type 1 lesion of the CNV. Therapy with aflibercept was continued; however, while the intraretinal edema continued to improve, atrophy developed in the macula and the BCVA worsened to 43 ETDRS letters. Conclusions Ranibizumab nonresponse in a neovascular age-related macular degeneration is not uncommon. However, to our knowledge, this is the first described case of an asymmetric response to ranibizumab in a mixed CNV. While the type 2 lesion of the CNV reacted swiftly to the ranibizumab therapy, the type 1 lesion continued to grow. As with some other cases of ranibizumab resistance, switching to aflibercept proved effective.

scholarly journals Comparison of optical coherence tomography angiography features in type 1 versus type 2 choroidal neovascular membranes secondary to age-related macular degeneration

2021 ◽  
Vol 10 (2) ◽  
pp. 25-31
Author(s):  
Yasin Sakir Goker ◽  
Gokhan Demir
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Optical Coherence Tomography Angiography ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Dead Tree ◽  
Flow Area ◽  
Age Related

Background: Optical coherence tomography angiography (OCTA) is an advanced imaging modality that provides high resolution images at the level of different retinal layers. This study aime to evaluate choroidal neovascular membranes (CNVMs) secondary to age-related macular degeneration (AMD) quantitatively and qualitatively, according to their classification, morphological features, and flow areas, using OCTA. Methods: In this descriptive, comparative, cross-sectional study, CNVMs were divided into 2 groups according to their classification as type 1 or type 2 neovascularization. Mixed CNVMs were excluded from the study. The size (mm2) and the flow area (mm2) of the CNVMs were calculated via OCTA and the presence of the perivascular halo and loop anastomoses were analyzed. The morphological appearance of the CNVMs were classified as: medusa, sea-fan, lacy-wheel, glomerular, dead tree, and mature vascular networks. Results: Of the 85 eyes assessed for eligibility, 45 eyes of 34 individuals with CNVM were enrolled in this retrospective study. Twenty-eight eyes had type 1 and 17 eyes had type 2 CNVMs. The mean size and flow area were greater in type 1 than in type 2 CNVMs (mean ± standard deviation [SD], 6.69 ± 4.54 and 3.61 ± 3.56 mm2 versus 3.04 ± 1.98 and 1.77 ± 1.62 mm2; P = 0.044 and 0.046, respectively). Among the 22 eyes with type 1 CNVMs and the 9 eyes with type 2 CNVMs, 31 eyes had exudative membranes. Among the eyes with exudative CNVMs, 22 eyes had a perivascular halo and 22 eyes had loop anastomoses; this was significantly more than in the non-exudative eyes (P = 0.042 and 0.041, respectively). The lacy-wheel (38.7%) and dead tree (71.4%) patterns were the most frequent morphological appearance of the CNVMs in the exudative and non-exudative membranes, respectively. Conclusions: OCTA provides objective documantation about CNVMs. A perivascular dark halo around CNVMs could be a criterion to define exudative membranes activity. How to cite this article: Goker YS, Demir G. Comparison of optical coherence tomography angiography features in type 1 versus type 2 choroidal neovascular membranes secondary to age-related macular degeneration. Med Hypothesis Discov Innov Ophthalmol. 2021 Summer; 10(2): 25-31. https://doi.org/10.51329/mehdiophthal1423

Optical Coherence Tomography Angiography of Type 1 Neovascularization in Age-Related Macular Degeneration

2015 ◽  
Vol 160 (4) ◽  
pp. 739-748.e2 ◽  
Author(s):  
Laura Kuehlewein ◽  
Mayank Bansal ◽  
Tamara L. Lenis ◽  
Nicholas A. Iafe ◽  
SriniVas R. Sadda ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Optical Coherence Tomography Angiography ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Age Related

scholarly journals The Presence of Intra- or Subretinal Fluid during the Loading Phase in the Treatment of Exudative Age-Related Macular Degeneration with Intravitreal Ranibizumab Assessed by Optical Coherence Tomography

2015 ◽  
Vol 234 (2) ◽  
pp. 61-66
Author(s):  
Andreas Ebneter ◽  
Boris Gekkiev ◽  
Bhuvan Chanana ◽  
Sebastian Wolf ◽  
Martin S. Zinkernagel
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Degeneration ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Intravitreal Ranibizumab ◽  
Visual Improvement ◽  
Age Related ◽  
Treatment Naïve

Purpose: To assess intra- and subretinal fluid during the loading phase with intravitreal ranibizumab in exudative age-related macular degeneration and to quantify the accuracy of crosshair scan spectral-domain optical coherence tomography with regard to retinal fluid. Methods: This is a retrospective study of 31 treatment-naive patients who received 3 monthly intravitreal ranibizumab injections. Visual acuity and the presence of retinal fluid were assessed at each visit using volume and crosshair scan protocols. Results: Visual acuity improved and central retinal thickness decreased significantly during the loading phase. However, retinal fluid persisted in two thirds of the patients. The accuracy of the crosshair scan to detect fluid was 93%. Conclusions: A substantial proportion of eyes had persistent fluid after 3 months of ranibizumab injections. However, visual improvement was independent of residual fluid. Message: Crosshair scans detect relevant collections of retinal fluid accurately and may be sufficient in daily clinical practice.

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