Formation of retinal pigment epithelium rupture in a patient with wet form of macular degeneration against the background of anti-vegf therapy

Purpose. To present possible complications of anti-VEGF therapy in patients with high pigment epithelial detachment on the basis of a clinical case. Methods. A clinical case of pigment epithelium rupture formation in a patient on the background of anti-VEGF therapy with aflibercept. Results. The presented clinical case clearly demonstrates the significance of OCT-signs of high risk of pigment epithelium rupture formation. The question of anti-VEGF therapy continuation in case of detection of these signs in a patient with continued activity of the process, as well as the choice of the drug, remains open. Key words: wet macular degeneration; pigment epithelium detachment; pigment epithelium rupture; aflibircept; ranibizumab.

The morphology of choroidal neovascularization in chronic central serous chorioretinopathy presenting with flat, irregular pigment epithelium detachment

Purpose To evaluate morphological characteristics of choroidal neovascularization in chronic central serous chorioretinopathy (CSC) presenting with flat and irregular pigment epithelium detachment (FIPED) by means of innovative multimodal imaging. Methods In this observational cross-sectional study, we examined 10 consecutive patients affected by chronic CSC and FIPED using fluorescein angiography (FA), indocyanine-green angiography (ICGA) and optical coherence tomography angiography (OCTA). A qualitative analysis of the nature and characteristics of neovascular membrane was performed, combining available multimodal imaging and literature data. Results Multiple areas of retinal pigment epithelium alterations, macular hypo- and hyperpigmentation and atrophic areas were identified. Spectral domain OCT (SD-OCT) showed subretinal fluid in 80% of eyes and the ‘double layer sign’ in all patients. Late FA phases showed staining areas without leakage in all eyes; ICGA showed a hyperfluorescent plaque with surrounding hypofluorescence in 80% of patients. OCTA detected characteristic neovascular networks in the outer retina within the FIPEDs, classified as filamentous vessels with a pruned tree-like pattern in five eyes and a tangled pattern in three eyes. The choriocapillaris network showed dark areas in 80% of eyes and diffuse dark spots in all eyes. Conclusion Multimodal imaging completes clinical characterization of FIPEDs in chronic CSC. This study using OCTA technology describes the phenotype of hidden neovascular lesions in shape and morphology.

Optical Coherence Tomography Angiography (OCTA) information content in the diagnosis of type 1 choroidal neovascularization combined with pigment epithelium detachment

Purpose of the study is to determine the reliability of OCT angiography in the diagnosis of type 1 choroidal neovascularization (CNV) in wet age-related macular degeneration depending on the height of pigment epithelium detachment (PED).Material and methods. The study included 82 patients (114 eyes) with confirmed type 1 CNV, who were examined using spectral OCT and OCTA. The patients were divided into two groups depending on PED height: group 1 consisted of 69 eyes with PED height less than 300 μm, while group 2 (45 eyes) had PED height of more than 300 μm. A separate comparative analysis of the visualization of pathological vessels was made in a group of untreated patients (56 eyes) and a group of patients (58 eyes) treated with angiogenesis inhibitors.Results. In group 1 with a PED height less than 300 μm (167.0 ± 60.4 μm) OCTA detected blood flow along abnormal vessels in 100 % of cases. In group 2 with a PED height above 300 μm (484.7 ± 131.9 μm) CNV vessels were visualized in 24.4 % of eyes. The PED height of patients after intravitreal injections of angiogenesis inhibitors (IVI IA) ranged from 38 to 683 μm (221 ± 133 μm). According to OCTA visualization of type 1 CNV vasculature was noted in 55 eyes (94.8 %). In patients who received no antiangiogenic therapy, with a PED height 59 - 800 μm (238 ± 149 μm) CNV was visualized in 41 % of cases (23 eyes).Conclusion. OCTA showed high reliability in the diagnosis of type 1 CNV with low PED. This method was significantly less informative when the height of the neovascular PED exceeded 300 μm, with the exception of PED after IVI IA.

Reliability of retinal pathology quantification in age-related macular degeneration: Implications for clinical trials and machine learning applications

ABSTRACTPurposeTo investigate the inter-reader agreement for grading of retinal alterations in age-related macular degeneration (AMD) using a reading center setting.MethodsIn this cross-sectional case series, spectral domain optical coherence tomography (OCT, Topcon 3D OCT, Tokyo, Japan) scans of 112 eyes of 112 patients with neovascular AMD (56 treatment-naive, 56 after three anti-vascular endothelial growth factor injections) were analyzed by four independent readers. Imaging features specific for AMD were annotated using a novel custom-built annotation platform. Dice score, Bland-Altman plots, coefficients of repeatability (CR), coefficients of variation (CV), and intraclass correlation coefficients (ICC) were assessed.ResultsLoss of ellipsoid zone, pigment epithelium detachment, subretinal fluid, and Drusen were the most abundant features in our cohort. The features subretinal fluid, intraretinal fluid, hypertransmission, descent of the outer plexiform layer, and pigment epithelium detachment showed highest inter-reader agreement, while detection and measures of loss of ellipsoid zone and retinal pigment epithelium were more variable. The agreement on the size and location of the respective annotation was more consistent throughout all features.ConclusionsThe inter-reader agreement depended on the respective OCT-based feature. A selection of reliable features might provide suitable surrogate markers for disease progression and possible treatment effects focusing on different disease stages.Translational RelevanceThis might give opportunities to a more time- and cost-effective patient assessment and improved decision-making as well as have implications for clinical trials and training machine learning algorithms.

Long-Term Visual/Anatomic Outcome in Patients with Fovea-Involving Fibrovascular Pigment Epithelium Detachment Presenting Choroidal Neovascularization on Optical Coherence Tomography Angiography

Background: To evaluate long-term visual/anatomic outcome after anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with fovea-involving fibrovascular pigment epithelium detachment (PED) presenting with choroidal neovascularization (CNV) on optical coherence tomography angiography (OCTA). Methods: Patients with fibrovascular PED or subretinal CNV confirmed by OCTA who were treated by a relaxed treat-and-extend regimen for 2 years were retrospectively reviewed. The best-corrected visual acuity (BCVA) and central subfield retinal thickness (CST) before and after anti-VEGF injection were analyzed. Furthermore, changes in photoreceptor layer (PRL) thickness and outer retinal bands in the fovea after injection were evaluated. Results: A total of 31 eyes with fibrovascular PED and 24 eyes with subretinal CNV were included. Following a relaxed treat-and-extend regimen with anti-VEGF agents, BCVA and CST were improved, and the PRL thickness was decreased significantly. There were no differences in BCVA, CST, changes in PRL thickness, or the status of outer retinal bands between the groups. However, the difference in the amount of decrease in PRL thickness between the two groups was increased at 2 years, and the slope tended to be steeper in the subretinal CNV group. Conclusions: Exudative age-related macular degeneration (AMD) with fibrovascular PED or subretinal CNV showed good visual/anatomic outcomes after anti-VEGF treatment, regardless of the CNV type. By 2 years, fibrovascular PED did not have an additional protective effect on the outer retina, compared with subretinal CNV over 2 years. Further follow-up study might be needed to conclude that fibrovascular PED has a protective effect on the surrounding photoreceptor area.