scholarly journals High Reflectivity and Low Reflectivity Properties on OCTA Influence the Detection of Macular Neovascularization in AMD

2021 ◽  
Vol 9 ◽  
Author(s):  
Alessandro Arrigo ◽  
Emanuela Aragona ◽  
Alessandro Bordato ◽  
Alessia Amato ◽  
Andrea Saladino ◽  
...  
Keyword(s):  
Blood Flow ◽  
Age Related Macular Degeneration ◽  
Cross Sectional ◽  
High Reflectivity ◽  
Age Related ◽  
Flow Features ◽  
The Relationship ◽  
Good Agreement

Background: In this study, we aimed to discriminate high reflectivity and low reflectivity macular neovascularization (MNV) lesions secondary to age-related macular degeneration (AMD)and to assess the influence of blood flow features on the amount of MNV detected by optical coherence tomography angiography (OCTA).Methods: The study was designed as observational, cross-sectional. Type 1 and type 2 MNV lesions were included. All the patients underwent fluorescein angiography (FA), indocyanine green angiography (ICGA) and OCTA. MNV size was calculated on early FA for type 2 MNV and on both early and late phases of ICGA for type 1 lesions. From OCTA, we calculated both MNV size and MNV reflectivity. We assessed the agreement between FA/ICGA and OCTA MNV sizes. Moreover, we studied the relationship between MNV reflectivity properties and MNV OCTA detection.Results: Fifty eyes (50 patients) were included. MNV was identified as follows: 35 /70%) type 1 and 15 (30%) type 2. We found a good agreement between early ICGA size and OCTA size for type 1 MNV (2.10 ± 1.91 mm2 vs 2.09 ± 1.87 mm2; p > 0.05), whereas MNV lesions turned out to be remarkably bigger on late ICGA phase (3.41 ± 2.87 mm2; p < 0.01). Interestingly, OCTA well-matched with FA in terms of MNV size for type 2 lesions (2.36 ± 2.15 mm2 vs 2.37 ± 2.25 mm2). MNV reflectivity was higher in type 2 MNV and it was strongly associated with the OCTA ability to reconstruct the neovascular network.Conclusion: Our study quantitatively showed that MNV filling pattern and MNV blood flow reflectivity features influence the OCTA detection of the MNV in its entirety.

scholarly journals Drusen Characteristics of Type 2 Macular Neovascularization in Age-related Macular Degeneration

2020 ◽  
Author(s):  
Daniel Ahmed ◽  
Martin Stattin ◽  
Anna-Maria Haas ◽  
Alexandra Graf ◽  
Katharina Krepler ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Care Center ◽  
Age Related Macular Degeneration ◽  
Retrospective Data Analysis ◽  
Age Related ◽  
The Relationship ◽  
Subretinal Drusenoid Deposits ◽  
Medical Retina ◽  
Fellow Eyes

Abstract Background: To assess the relationship between drusen characteristics and type 2 macular neovascularization (MNV) in age-related macular degeneration (AMD)Methods: Retrospective data analysis of eyes previously diagnosed with neovascular AMD in a tertiary eye care center (Medical Retina Unit, Rudolf Foundation Hospital, Vienna, Austria) between June 2008 and December 2017. Drusen subtypes, fibrosis, atrophy and subfoveal choroidal thickness (SFCT) of both eyes in patients with type 2 MNV lesions were categorized based on multimodal imaging.Results: Type 2 MNV was diagnosed in 27 (3.2%) of 835 eyes (749 patients). Drusen characteristics in type 2 MNV were observed as followed: drusen < 63 mm in 2 eyes (7.4%), drusen ≥ 63 mm in 10 eyes (37%), subretinal drusenoid deposits (SDD) in 8 eyes (29.6%), cuticular drusen in 2 eye (7.4%) and no drusen were evident in 10 eyes (37%). Drusen distribution in 23 fellow eyes was detected as followed: drusen < 63 mm in 2 eyes (8.7%), drusen ≥ 63 mm in 9 eyes (39.1%), SDD in 5 eyes (21.7%), cuticular drusen in 1 eye (4.3%) and no drusen were evident in 9 eyes (39.1%). Mean SFCT was 140 ± 49 mm in affected eyes and 152 ± 41 mm in the fellow eyes. Patients with drusen or SDD were significantly younger (mean 70.88 ± 6.85, p=0.04) than patients without deposits (mean 77.40 ± 5.74). Conclusions: Type 2 MNV remains a rare entity in AMD. It was frequently seen in the absence ofdrusen, a hallmark of AMD. These findings contribute to the heterogeneity of phenotypes related to pure type 2 lesions.

scholarly journals Changes in the OCT angiographic appearance of type 1 and type 2 CNV in exudative AMD during anti-VEGF treatment

2019 ◽  
Vol 4 (1) ◽  
pp. e000369 ◽  
Author(s):  
Henrik Faatz ◽  
Marie-Louise Farecki ◽  
Kai Rothaus ◽  
Matthias Gutfleisch ◽  
Daniel Pauleikhoff ◽  
...  
Keyword(s):  
Age Related Macular Degeneration ◽  
Fluid Distribution ◽  
Repeated Treatment ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Anti Vegf ◽  
Age Related ◽  
Sd Oct

ObjectiveOptical coherence tomography angiography (OCT-A) enables detailed visualisation of the vascular structure of choroidal neovascularisation (CNV). The aim of this study was to determine whether mathematically ascertained OCT-A vascular parameters of type 1 and type 2 CNV in exudative age-related macular degeneration (AMD) change during antivascular endothelial growth factor (anti-VEGF) treatment. The OCT-A vascular parameters were also compared with previously obtained activity parameters (fluid distribution on spectral domain OCT (SD-OCT)) to establish whether they could potentially be used as further ‘activity parameters’ for assessment of anti-VEGF treatment.Methods and AnalysisWe evaluated 27 eyes of 27 patients (mean follow-up 9.8 months) with type 1, type 2 or mixed CNV who had received anti-VEGF treatment (IVAN scheme). The parameters analysed were area (aCNV), total length of all vessels (tlCNV), overall number of vascular segments (nsCNV) and fractal dimension (FD) of the CNV. The changes in each of these parameters were correlated with the central foveal thickness (CFT).ResultsRegression and renewed perfusion of the CNV corresponded with the decrease or increase, respectively, of macular fluid distribution on SD-OCT. The increase and decrease of CFT during anti-VEGF treatment were highly significantly correlated with changes in FD (p<0.00001), aCNV (p<0.00001), tlCNV (p<0.00001) and nsCNV (p<0.00001).ConclusionOCT-A enables detailed analysis of AMD with regard to FD, aCNV, tlCNV and nsCNV. As the changes in these parameters correlate closely with changes on SD-OCT, they can be used as new activity parameters, alongside fluid distribution, for assessment of treatment effect and as parameters of stabilisation or the need for repeated treatment.

scholarly journals Analyses of the effects of persistent subretinal fluid on visual/anatomic outcomes according to the type of macular neovascularization during the relaxed treat-and-extend protocol in age-related macular degeneration patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kyung Tae Kim ◽  
Ju Byung Chae ◽  
Seungheon Lee ◽  
Eoi Jong Seo ◽  
Dong Yoon Kim
Keyword(s):  
Macular Degeneration ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Long Term Effects ◽  
Treat And Extend ◽  
Anti Vegf ◽  
Age Related ◽  
Treat And Extend Regimen

Abstract Background To analyze the long-term effects of persistent subretinal fluid (SRF) on visual/anatomic outcomes according to the type of macular neovascularization (MNV) during relaxed treat-and-extend regimen with anti-vascular endothelial growth factor (anti-VEGF) agents in age-related macular degeneration (AMD) patients. Methods Patients with fovea-involving type 1 or type 2 MNV, treated with a relaxed treat-and-extend regimen for 2 years were retrospectively reviewed. Eyes with SRF observed more than three times per year were defined as the ‘persistent SRF (+) group’. To exclude the effects of IRF as much as possible, the eyes with persistent IRF were excluded. The effects of persistent SRF on the best-corrected visual acuity (BCVA), central subfield retinal thickness (CST), and changes in the photoreceptor layer (PRL) thickness and outer retinal bands (external limiting membrane, ellipsoid zone, and cone outer segment tip line) after anti-VEGF injection were analyzed for each MNV type. Results Seventy-seven eyes with type 1 MNV (44 eyes with persistent SRF) and 53 eyes with type 2 MNV (18 eyes with persistent SRF) were enrolled. Following a relaxed treat-and-extend regimen with anti-VEGF agents, BCVA and CST improved for each MNV type. In comparison between persistent SRF (+) and persistent SRF (−) group, there were no differences in the amount of change in BCVA and CST between the two groups for each MNV type during 2-year follow-up periods. In addition, there were no differences in the amount of reduction in PRL thickness and state of the outer retinal bands between the two groups for each MNV type. Conclusions Using a relaxed treat-and-extend regimen with anti-VEGF agents, persistent SRF did not have additional effects on visual and anatomic outcomes by 2 years, regardless of the MNV type.

scholarly journals Plasma carotenoids and diabetic retinopathy

2008 ◽  
Vol 101 (2) ◽  
pp. 270-277 ◽  
Author(s):  
Laima Brazionis ◽  
Kevin Rowley ◽  
Catherine Itsiopoulos ◽  
Kerin O'Dea
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Vitamin A ◽  
Cross Sectional Study ◽  
Age Related Macular Degeneration ◽  
Cross Sectional ◽  
Carotenoid Concentration ◽  
Age Related ◽  
Lifestyle Questionnaire ◽  
The Relationship

Diabetic retinopathy increases with duration of diabetes and may be associated with carotenoid status. Carotenoids alter the pro-oxidation/antioxidation balance, and circulating levels depend largely on dietary intake. Lower levels have been reported in diabetes and age-related macular degeneration; however, little is known of the relationship between carotenoids and diabetic complications. Consequently, the purpose of the present study was to evaluate the relationship between plasma carotenoids and diabetic retinopathy. We assessed the carotenoid–retinopathy relationship in 111 individuals with type 2 diabetes in a community-based, cross-sectional study. We photodocumented retinal status and used HPLC to measure plasma carotenoid concentrations. Data for clinical and demographic variables and risk factors for diabetic retinopathy were obtained from 24 h urine and fasting blood samples, and an interviewer-assisted lifestyle questionnaire. We found that the combined lycopene and lutein/zeaxanthin (non-pro-vitamin A (non-PVA) carotenoid) concentration when compared with the pro-vitamin A (PVA) carotenoids (α-carotene, β-carotene and β-cryptoxanthin) was significantly lower in the retinopathy than non-retinopathy group (OR 1·2 (95 % CI 1·0, 1·4)v.1·6 (95 % CI 1·4, 1·7), respectively;P = 0·009). A higher non-PVA:PVA ratio also predicted a lower risk of diabetic retinopathy, after adjustment for potential confounders (OR 0·33 (95 % CI 0·12, 0·95);P = 0·039). Finally, a higher concentration of PVA carotenoids was associated with greater odds of diabetic retinopathy, after adjustment for risk factors (P = 0·049). We suggest synergies between carotenoids are implicated in diabetic retinopathy, independent of established risk factors. Importantly, our observations indicate dietary modulation of retinopathy risk may be possible by increasing intakes of lutein- and lycopene-rich foods.

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 Drusen Characteristics of Type 2 Macular Neovascularization in Age-related Macular Degeneration

2019 ◽  
Author(s):  
Daniel Ahmed ◽  
Martin Stattin ◽  
Anna-Maria Haas ◽  
Alexandra Graf ◽  
Katharina Krepler ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Care Center ◽  
Age Related Macular Degeneration ◽  
Retrospective Data Analysis ◽  
Age Related ◽  
Imaging Results ◽  
The Relationship ◽  
Subretinal Drusenoid Deposits ◽  
Fellow Eyes

Abstract Background To assess the relationship between drusen characteristics and type 2 macular neovascularization (MNV) in age-related macular degeneration (AMD). Methods Retrospective data analysis of eyes previously diagnosed with neovascular AMD in a tertiary eye care center (Medical Retina Unit, Rudolf Foundation Hospital, Vienna, Austria) between June 2008 and December 2017. Drusen subtypes, fibrosis, atrophy and subfoveal choroidal thickness (SFCT) of both eyes in patients with type 2 MNV lesions were categorized based on multimodal imaging. Results Type 2 MNV was diagnosed in 27 (3.2%) of 835 eyes (749 patients). Drusen characteristics in type 2 MNV were observed as followed: drusen < 63 m in 2 eyes (7.4%), drusen ≥ 63 mm in 10 eyes (37%), subretinal drusenoid deposits (SDD) in 8 eyes (29.6%), cuticular drusen in 2 eye (7.4%) and no drusen were evident in 10 eyes (37%). Drusen distribution in 23 fellow eyes was detected as followed: drusen < 63 mm in 2 eyes (8.7%), drusen ≥ 63 mm in 9 eyes (39.1%), SDD in 5 eyes (21.7%), cuticular drusen in 1 eye (4.3%) and no drusen were evident in 8 eyes (34.8%). Mean SFCT was 140 ± 49 mm in affected eyes and 152 ± 41 mm in the fellow eyes. Conclusions Type 2 MNV remains a rare entity in AMD. It was frequently seen in the absence of drusen, a hallmark of AMD. These findings suggest other biological pathways related to pure type 2 lesions.

scholarly journals Drusen Characteristics of Type 2 Macular Neovascularization in Age-related Macular Degeneration

2020 ◽  
Author(s):  
Daniel Ahmed ◽  
Martin Stattin ◽  
Anna-Maria Haas ◽  
Alexandra Graf ◽  
Katharina Krepler ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Care Center ◽  
Age Related Macular Degeneration ◽  
Retrospective Data Analysis ◽  
Age Related ◽  
Imaging Results ◽  
The Relationship ◽  
Subretinal Drusenoid Deposits ◽  
Fellow Eyes

Abstract Background To assess the relationship between drusen characteristics and type 2 macular neovascularization (MNV) in age-related macular degeneration (AMD) Methods Retrospective data analysis of eyes previously diagnosed with neovascular AMD in a tertiary eye care center (Medical Retina Unit, Rudolf Foundation Hospital, Vienna, Austria) between June 2008 and December 2017. Drusen subtypes, fibrosis, atrophy and subfoveal choroidal thickness (SFCT) of both eyes in patients with type 2 MNV lesions were categorized based on multimodal imaging. Results Type 2 MNV was diagnosed in 27 (3.2%) of 835 eyes (749 patients). Drusen characteristics in type 2 MNV were observed as followed: drusen < 63 mm in 2 eyes (7.4%), drusen ≥ 63 mm in 10 eyes (37%), subretinal drusenoid deposits (SDD) in 8 eyes (29.6%), cuticular drusen in 2 eye (7.4%) and no drusen were evident in 10 eyes (37%). Drusen distribution in 23 fellow eyes was detected as followed: drusen < 63 mm in 2 eyes (8.7%), drusen ≥ 63 mm in 9 eyes (39.1%), SDD in 5 eyes (21.7%), cuticular drusen in 1 eye (4.3%) and no drusen were evident in 9 eyes (39.1%). Mean SFCT was 140 ± 49 mm in affected eyes and 152 ± 41 mm in the fellow eyes. Patients with drusen or SDD were significantly younger (mean 70.88 ± 6.85, p=0.04) than patients without deposits (mean 77.40 ± 5.74). Conclusions Type 2 MNV remains a rare entity in AMD. It was frequently seen in the absence of drusen, a hallmark of AMD. These findings contribute to the heterogeneity of phenotypes related to pure type 2 lesions.

Two-year results of a combined regimen of aflibercept treatment in three types of choroidal neovascular membrane in the wet form of age-related macular degeneration: Real-life evidence in the Czech Republic

2020 ◽  
pp. 112067212097119
Author(s):  
Alexandr Stepanov ◽  
Jan Nemcansky ◽  
Miroslav Veith ◽  
Katerina Manethova ◽  
Marketa Stredova ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Real Life ◽  
Response To Therapy ◽  
Age Related Macular Degeneration ◽  
First Year ◽  
Choroidal Neovascular Membrane ◽  
Age Related ◽  
Second Year

Aim: To present the results of a 2-year therapy with aflibercept in real-life practice in a mixed regimen in patients with a neovascular form of age-related macular degeneration (nAMD) and to evaluate the treatment response of various types of choroidal neovascular membranes (CNV) – occult (Type 1), classic (Type 2) and minimally classic (Type 4). Methods: This was a multicentric, prospective, observational study of a series of cases. Patients diagnosed with the wet form of AMD were treated in a fixed regimen (3 injections at intervals of 1 month and then injections at 8-week intervals) in the first year, and in a pro re nata regimen (PRN) in the second year. The period of investigation was 24 months. The development of the best corrected visual acuity (BCVA) was evaluated by means of ETDRS optotypes (Early Treatment Diabetic Retinopathy Study) and the central retinal thickness (CRT). Measurements were performed prior to the commencement of therapy and then after 4, 8, 12, 16, 20 and 24 months. Results: The therapeutically naïve group consisted of 135 eyes of 135 patients. Sixty-one eyes suffered from CNV of the 1st type, 50 eyes from CNV of the 2nd type and 24 eyes from CNV of the 4th type. The average baseline of BCVA ± SD in Type 1 CNV was 56.1 ± 10.8 letters of ETDRS, and then, respectively, 62.2 ± 12.9 letters, 62.8 ± 15.1 letters and 59.4 ± 13.2 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD for Type 1 CNV was 442.4 ± 194.9 µm, and then 302.5 ± 144.4 µm, 277.7 ± 106.5 µm and 327.6 ± 138.6 µm at months 4, 12 and 24. The average baseline value of BCVA ± SD in Type 2 CNV was 55.6 ± 9.9 letters of ETDRS, and then 62.5 ± 11.1 letters, 62.5 ± 14.2 letters and 60.6 ± 15.1 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD in Type 2 CNV was 446.8 ± 159.1 µm, and then 327.4 ± 127.0 µm, 316.7 ± 139.1 µm and 352.5 ± 132.4 µm at 4, 12 and 24 months. In Type 4 CNV, the average baseline value of BCVA ± SD was 56.7 ± 9.0 letters of ETDRS, and then 59.1 ± 10.6 letters, 59.2 ± 12.6 letters and 58 ± 8.8 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD in Type 4 CNV was 492.1 ± 187.0 µm, and then 333.3 ± 137.5 µm, 326.7 ± 122.4 µm and 328.4 ± 132 µm at months 4, 12 and 24. All these changes were statistically significant ( p < 0.05). Conclusion: Therapy with aflibercept in a mixed regimen in patients with the wet form of AMD during the investigation resulted in a statistically significant improvement in BCVA and decrease in CRT in both the occult and classic type of CNV. Both the functional and anatomical response to therapy was worse in the minimally classic type (Type 4) of CNV. Summary declaration: Patients suffering from the neovascular form of age-related macular degeneration were treated with aflibercept in a mixed regimen (fixed in the first year and PRN in the second year). After 24 months of examination, a significant improvement of both morphological and functional results was observed in three types of choroidal neovascular membrane.

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

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