scholarly journals Combined Quantitative and Qualitative Optical Coherence Tomography Angiography Biomarkers for Predicting Active Neovascular Age-related Macular Degeneration

2021 ◽  
Author(s):  
Cherng-Ru Hsu ◽  
Tso-Ting Lai ◽  
Yi-Ting Hsieh ◽  
Tzyy-Chang Ho ◽  
Chung-May Yang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Optical Coherence Tomography Angiography ◽  
Vessel Density ◽  
Age Related Macular Degeneration ◽  
Active Group ◽  
Optical Coherence ◽  
Qualitative And Quantitative ◽  
Anti Vegf ◽  
Age Related

Abstract Purpose: To investigate choroidal neovascularization (CNV) activity after anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with neovascular age-related macular degeneration (nAMD) by optical coherence tomography angiography (OCTA) and to determine whether combined qualitative and quantitative biomarkers can achieve high predictive accuracy to guide treatment decisions.Methods: Patients diagnosed with type 1 or type 2 CNV via multimodal imaging who had received anti-VEGF treatment were retrospectively reviewed. Qualitative and quantitative CNV responses on OCTA after serial injections were analyzed, and the assessment was correlated with their structural OCT scans. The enrolled eyes were divided into two groups: eyes with exudative signs on structural OCT and those without exudative signs. Results: Fifty-seven eyes of 56 patients were included in the study. Twenty-eight eyes (49.1%) were classified as the “active group”, and 29 eyes (50.9%) were categorized as the “silent group”. Qualitative biomarkers of CNV showed significant differences between the two groups (branching capillaries: 50.0% vs 6.9%, p < 0.001; anastomoses and loops: 78.6% vs 13.8%, p < 0.001; peripheral arcade: 39.3% vs 10.3%, p = 0.015, and hypointense halo: 82.1% vs 41.4%, p = 0.003). A significantly higher vessel density was found in the active group (41.8 ± 12.0% vs 31.0 ± 11.5%, p=0.002). “Anastomoses and loops” and “vessel density” predicted an active CNV status with a probability of 93.7% and achieved the best performance. Conclusions: The combination of two potential biomarkers of CNV on OCTA predicts a high possibility of an active disease status that suggests optimal decisions to treat.

scholarly journals Combined quantitative and qualitative optical coherence tomography angiography biomarkers for predicting active neovascular age-related macular degeneration

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cherng-Ru Hsu ◽  
Tso-Ting Lai ◽  
Yi-Ting Hsieh ◽  
Tzyy-Chang Ho ◽  
Chung-May Yang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Disease Activity ◽  
Macular Degeneration ◽  
Optical Coherence Tomography Angiography ◽  
Vessel Density ◽  
Age Related Macular Degeneration ◽  
Active Group ◽  
Optical Coherence ◽  
Qualitative And Quantitative ◽  
Age Related

AbstractTo investigate choroidal neovascularization (CNV) characteristics after anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with neovascular age-related macular degeneration by optical coherence tomography angiography (OCTA) and to assess the potential predictive role of combined qualitative and quantitative biomarkers for disease activity. Patients diagnosed with type 1 or type 2 CNV via multimodal imaging who had received anti-VEGF treatment were retrospectively reviewed. Qualitative and quantitative CNV responses on OCTA after serial injections were analyzed. The enrolled eyes were divided into two groups based on treatment intervals during follow-up, including an active group with less than 12 weeks intervals and a stable group with 12 weeks or longer intervals. Fifty-six eyes of 56 patients were included in the study. Twenty-seven eyes (48.2%) were classified as the “active group”, and 29 eyes (51.8%) were categorized as the “silent group”. Qualitative biomarkers of CNV showed significant differences between the two groups (branching capillaries: 48.1% vs 6.9%, p = 0.001; anastomoses and loops: 81.5% vs 13.8%, p < 0.001; peripheral arcade: 40.7% vs 10.3%, p = 0.013, and hypointense halo: 81.5% vs 41.4%, p = 0.002). A significantly higher vessel density was found in the active group (median 39.6% vs 30.5%, p = 0.003). “Anastomoses and loops” and “vessel density” predicted an active CNV status with a probability of 93.7% and achieved the best performance. The combination of two potential biomarkers of CNV on OCTA shows good discrimination for the prediction of recurrent exudation auxiliary to structural OCT that might associate with disease activity.

scholarly journals Quantification of Optical Coherence Tomography Angiography in Age and Age-related Macular Degeneration using Vessel Density analysis

2019 ◽  
Author(s):  
Ehsan Vaghefi ◽  
Sophie Hill ◽  
Hannah M Kersten ◽  
David Squirrell
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Optical Coherence Tomography Angiography ◽  
Retinal Vessel ◽  
Vessel Density ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Age Related ◽  
Capillary Plexus ◽  
Retinal Vessel Density

AbstractPurposeTo determine whether vessel density (VD) as measured by optical coherence tomography angiography (OCT-A) provide insights into retinal and choriocapillaris vascular changes with ageing and intermediate dry age related macular degeneration (AMD).MethodsSeventy-five participants were recruited into three cohorts; young healthy (YH) group, old healthy (OH) and those at high-risk for exudative AMD. Raw OCT and OCT-A data from TOPCON DRI OCT Triton were exported using Topcon IMAGENET 6.0 software, and 3D datasets were analysed to determine retinal thickness and vessel density.ResultsCentral macular thickness measurements revealed a trend of overall retinal thinning with increasing age. VD through the full thickness of the retina was highest in ETDRS sector 4 (the inferior macula) in all the cohorts. Mean VD was significantly higher in the deep capillary plexus than the superficial capillary plexus in all ETDRS sectors in all cohorts but there was no significant difference noted between groups. Choriocapillaris VD was significantly lower in all ETDRS sectors in the in the AMD group compared with the YH and the OH groups.ConclusionsRetinal vessel density maps, derived from the retinal plexi are not reliable biomarkers for assessing the ageing macular. Our non-proprietary analysis of the vascular density of the choriocapillaris revealed a significant drop off of VD with age and disease but further work is required to corroborate this finding. If repeatable, choriocapillaris VD may provide a non-invasive biomarker of healthy ageing and disease.Brief SummaryIn this manuscript, we have studied the potential of retinal vessel density as measured by optical coherence tomography angiography (OCT-A), as a biomarker for detection of high-risk of developing exudative age-related macular degeneration (AMD).

scholarly journals Predictors of neovascular activity during neovascular age-related macular degeneration treatment based on optical coherence tomography angiography

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kunho Bae ◽  
Hyo Jung Kim ◽  
Yong Kyun Shin ◽  
Se Woong Kang
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Optical Coherence Tomography Angiography ◽  
Multivariate Regression Analysis ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Optical Coherence ◽  
Anti Vegf ◽  
Age Related ◽  
Endothelial Growth Factor

AbstractThe advent of anti-vascular endothelial growth factor (VEGF) therapies has remarkably improved the functional outcomes of neovascular age-related macular degeneration (nAMD) patients. However, there are guidelines on how to start treatment, the guidelines for discontinuing treatment are not yet clear. In this respect, the treat-extend-stop (TES) protocol have showed us the possibility of discontinuing treatment. In this study, we tried to investigate optical coherence tomography angiography (OCTA) biomarkers related to recurrence of neovascular activity in eyes with nAMD undergoing treatment using TES protocol. A total of 134 eyes with nAMD were divided into two groups (stop, non-stop) depending on whether they met criteria for stopping anti-VEGF treatment. Quantitative and qualitative OCTA parameters including the morphologic pattern of choroidal neovascularization (CNV) were compared between groups. Of these, 44 eyes (32.8%) were in the stop group and 90 eyes (67.2%) were in the non-stop group. In multivariate regression analysis, closed-circuit pattern of CNV and the presence of peripheral loop were associated with the non-stop group (all p < 0.001). Our results imply that the morphologic appearance of CNV on OCTA after anti-VEGF treatment may be a useful biomarker to predict weaning from treatment.

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

2020 ◽  
Vol 237 (11) ◽  
pp. 1312-1319 ◽  
Author(s):  
Marius Book ◽  
Martin Ziegler ◽  
Kai Rothaus ◽  
Henrik Faatz ◽  
Marie-Louise Gunnemann ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Optical Coherence Tomography Angiography ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Vascular Morphology ◽  
Anti Vegf ◽  
Age Related ◽  
Number Of Segments

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.

scholarly journals Relationship between Neovascular Density in Swept Source-Optical Coherence Tomography Angiography and Signs of Activity in Exudative Age-Related Macular Degeneration

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Martin Stattin ◽  
Julia Forster ◽  
Ahmed Daniel ◽  
Alexandra Graf ◽  
Katharina Krepler ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Optical Coherence Tomography Angiography ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Swept Source ◽  
Anti Vegf ◽  
Age Related ◽  
Active Disease

Purpose. To assess the relationship between signs of activity in exudative neovascular age-related macular degeneration (nAMD) following anti-vascular endothelial growth factor (anti-VEGF) treatment and morphology of choroidal neovascularization (CNV) based on neovascular density as imaged using swept source-optical coherence tomography angiography (SS-OCTA) in a qualitative manner. Methods. A single-cohort retrospective data analysis from one tertiary eye care center. Seventy-seven eyes of 72 patients were included and their charts reviewed which had been started on intravitreal injections with anti-VEGF for nAMD at least one year prior to enrollment. Clinically active disease was evaluated by slit-lamp fundus examination and spectral domain-OCT B-scans. Morphological appearance in SS-OCTA was characterized based on 5 different criteria and subsequently divided into 3 groups: predominantly hyperdense, minimally hyperdense, and hypodense lesions. Results. Fifty-eight eyes (75%) were considered clinically active and 19 eyes (25%) clinically inactive. CNV was depicted in 71 eyes (92%) by SS-OCTA and separated accordingly into predominantly hyperdense (32%), minimally hyperdense (34%), and hypodense lesions (34%). A borderline significant difference in the probability of neovascular activity for predominantly hyperdense lesions compared to hypodense lesions was detected (p=0.05). Conclusions. Hyperdense choroidal neovascularization based on qualitative assessment of flow density showed a significant relation to active disease. Inactivity could not be matched adequately. This study demonstrated the potential usefulness of SS-OCTA for guidance of treatment in age-related macular degeneration.

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