Purpose To evaluate the utility of optical coherence tomography-angiography (OCT-A) for monitoring activity, progression and response to therapy of neovascularisations (NVs) secondary to macular telangiectasia type 2 (MacTel).
Methods In a retrospective analysis, eyes with NVs secondary to MacTel were reviewed over a period of ≥8 months. Examinations at monthly intervals included visual acuity testing, dilated funduscopy, spectral domain-OCT and OCT-A. Eyes were treated with intravitreal VEGF (vascular endothelial growth factor)-inhibitors following a pro-re-nata (PRN) regime, and treatment decisions were based on morphological signs of activity as determined by B-scan OCT and funduscopy. Signs of neovascular activity were defined as an increase in retinal thickness, presence/increase of intraretinal/subretinal fluid and haemorrhages.
Results A total of 19 eyes from 17 patients were analysed. Patients were evaluated over a mean period of 13.4 months (range: 8.9 to 24.2). OCT-A permitted the monitoring of both treatment effects (regression) and progression (growth) of NVs, but not neovascular activity. The growth of neovascular vessels was detectable in OCT-A before signs of activity occurred on OCT. NVs showed a progressive growth over time despite PRN-treatment and preferentially grew and extended within areas characterised by a focal reduction of choriocapillaris perfusion.
Conclusions The results indicate that OCT-A represents a useful imaging modality for monitoring NV-progression and treatment effects in MacTel. We demonstrate its advantages over conventional B-scan OCT imaging, including an earlier detection of NV-progression, and propose an adjustment of the current OCT-controlled PRN treatment regime in order to prevent NV-progression and subsequent functional loss in neovascular MacTel.
Data availability statement
Data are available upon reasonable request. Additional information is available upon request.
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Contributors ST: study design, data acquisition, data analysis and interpretation; KH: data acquisition, critical revision of the work; MF: critical revision of the work for important intellectual content; FGH: critical revision of the work for important intellectual content.
Funding This work was supported by the Lowy Medical Research Institute, La Jolla, USA, and the German Research Foundation (research grant: project number: 406053827).
Competing interests Carl Zeiss Meditec, Inc has provided research material (PLEX Elite 9000) for the conduct of this study. The University of Bonn received imaging devices from Heidelberg Engineering, Heidelberg, Germany, and Carl Zeiss Meditec, Inc, Germany.
Provenance and peer review Not commissioned; externally peer reviewed.