CHANGES IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND DISEASE ACTIVITY IN TYPE 3 NEOVASCULARIZATION AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT.

PURPOSE: To investigate disease activity in patients with Type 3 neovascularization undergoing anti-vascular endothelial growth factor treatment through image analysis using optical coherence tomography angiography (OCTA). METHODS: Thirty-nine treatment-naive eyes with Type 3 neovascularization were included in the retrospective analysis. All patients were treated with three loading injections of an anti-vascular endothelial growth factor agent, followed by further injections as needed. Changes in the Type 3 lesion were analyzed through OCTA imaging during the 12 months of follow-up. RESULTS: The high-flow signal of Type 3 neovascularization on OCTA images disappeared in 46.2% eyes (19 of 39) and was persistent in 53.8% eyes (20 of 39) after loading injections. A persistent high-flow signal on OCTA after treatment was found at the sub-retinal pigment epithelium in 65.0% eyes (13 of 20), deep vascular plexus in 30.0% eyes (6 of 20), and outer neurosensory retina in 15.0% eyes (3 of 20). Eyes without lesions on OCTA images received significantly fewer injections (3.7 vs. 5.5; P = 0.016) and showed a longer retreatment-free period (mean 7.57 vs. 4.07 months; P = 0.002) during the 12-month follow-up than eyes with a persistent high-flow signal on OCTA. However, no significant between-group difference was observed in terms of improved visual acuity. CONCLUSION: Patients with Type 3 neovascularization who had no lesion on an OCTA scan after anti-vascular endothelial growth factor treatment showed a lower recurrence rate and maintained visual acuity with fewer injections than those with persistent high-flow lesions on an OCTA scan. Optical coherence tomography angiography may provide an additional biomarker for clinical guidance in the treatment and monitoring of disease activity in Type 3 neovascularization.

Responses of Types 1 and 2 Neovascularization in Age-Related Macular Degeneration to Anti-Vascular Endothelial Growth Factor Treatment: Optical Coherence Tomography Angiography Analysis.

Purpose: To compare the responses of types 1 (sub-pigment epithelial) and 2 (subretinal) neovascularization in neovascular age-related macular degeneration (AMD) to anti-vascular endothelial growth factor (VEGF) treatment. Methods: Fifty-five treatment-naïve neovascular AMD eyes (53 patients) were retrospectively included for analysis. All patients were treated with three loading injections of anti-VEGF agent, followed by further injections as required. The lesion size and vascular density of type 1 and 2 lesions before and after treatment for 12 months were analyzed using optical coherence tomography angiography (OCTA). Results: The mean lesion size of the type 1 neovascularization group (42 eyes) showed no significant change from 2.12 ± 1.01 mm2 at baseline to 2.08 ± 0.91 mm2 at 12 months (P = .682). However, the mean lesion size of type 2 neovascularization significantly decreased from 1.23 ± 0.93 mm2 at baseline to 0.79 ± 0.61 mm2 at 12 months (P = .022). The proportion of eyes with lesion sizes that decreased by more than 40% from baseline was also significantly higher for the type 2 compared to the type 1 neovascularization group (46.2% versus 11.9%, P = .007). Vascular density showed no significant changes for both groups after treatment and showed no association with the change in lesion size. There was no significant difference between the groups in terms of visual acuity improvement. Conclusion: OCTA analysis revealed different responses to anti-VEGF treatment depending on the location of neovascularization in neovascular AMD. Type 2 neovascularization was significantly regressed compared to type 1 neovascularization after anti-VEGF treatment. However, the changes in vascular density and visual outcome showed no significant differences between groups after 12 months of treatment.