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OCT-A Characteristics of Neo-vascular Membranes in Wet AMD-Possible Correlation to the Prognosis

Christina Vidinova, Dafina P. Antonova, Pravoslava T. Guguchkova, Kalin N. Vidinov

Background: OCT-A is a new imaging modality that provides the opportunity for noninvasive characterization and quantification of the microvasculature in wet AMD.

Purpose: The purpose of our study is to outline the different OCT-A characteristics of neovascular membranes in AMD in regard to their correlation with the effect of treatment and prognosis.

Methods: In our study 42 patients with wet AMD were enrolled. They were divided in 3 groups: 25 with Type 1 membranes (under RPE), 11 patients with Type 2 membranes and 6 with Type 3 RAP lesions. They all underwent a complete ophthalmological examination including VA, fundus photography, structural OCT (Rtvue, Optovue) and OCT-A (Angiophlex, Zeiss). All of the patients were treated with aflibercept (Eylea)-3 injections. They all were evaluated after the third injection.

Results: In the group of patients with type 1 CNV usually a medusa shaped neovascular complex with afferent vessel, originating in the choroid was observed on the OCT-A. In 9 cases the vessels were very rough and larger than in the general group. In the type 2 CNV group we visualized a neo-vascular network that grows from the choroid vasculature traverses the RPE-Bruch’s membrane complex into the sub-retinal space. These structures usually had glomeruli like shape. Type 3 CNV is seen on OCT-A as retinal-choroid anastomoses originating in the deep capillary plexus of the retina. The majority of patients from all groups improved VA and retinal thickness after the application of Eylea. Only in 2 cases no change was seen. Those were mainly cases with Type 1 CNV and with larger caliber of the vessels.

Conclusion: OCT angiography is a new imaging modality capable of revealing the morphological structure of Type 1, Type 2, and Type 3 neovascularization in exudative AMD. Visualizing the microarchitecture of the CNV membrane offers the prospect to evaluate the possible responses to therapy. Our results indicate that type 1 lesions, composed of larger, mature vessels are less responsive to anti-VEGF therapy and are with poor prognosis.