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Clinical science
Optical coherence tomography angiography in exudative age-related macular degeneration: a predictive model for treatment decisions
  1. Florence Coscas1,2,
  2. Marco Lupidi1,3,
  3. Jean François Boulet4,
  4. Alexandre Sellam4,
  5. Diogo Cabral1,5,6,
  6. Rita Serra7,
  7. Catherine Français1,
  8. Eric H Souied2,
  9. Gabriel Coscas1,2
  1. 1 Centre Ophtalmologique de l’Odeon, Paris, France
  2. 2 Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris Est Creteil, Creteil, France
  3. 3 Section of Ophthalmology, Department of Biomedical and Surgical Sciences, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
  4. 4 Paris VI University, UPMC, Paris, France
  5. 5 Retina Department, Instituto de Oftalmologia Dr Gama Pinto, Lisboa, Portugal
  6. 6 NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
  7. 7 Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
  1. Correspondence to Dr Florence Coscas, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil 94010, France; coscas.f{at}gmail.com

Abstract

Aims To evaluate on optical coherence tomography angiography (OCT-A), the predictive role of different qualitative findings of choroidal neovascularisations (CNV) in assessing the status of exudative age-related macular degeneration (eAMD) and to develop a potential model to predict the CNV activity.

Methods Retrospective review of the multimodal imaging records of patients with eAMD obtained during treatment for type 1 or type 2 CNV. The qualitative analysis of CNVs on OCT angiograms assessed the presence or absence of tiny branching vessels, loops, peripheral anastomotic arcades and choriocapillaris hypointense halo. These findings were then correlated with those of structural OCT scans. A score forecast was built and validated.

Results One hundred and twenty-six eAMD eyes were enrolled in the study. Exudation was observed in 90 eyes (71%) on structural OCT. The qualitative OCT-A analysis revealed: tiny branching vessels in 82.5% of the cases, vascular loops in 81.7%, peripheral anastomotic arcades in 66.7% and choriocapillaris hypointense halo in 54.8%. In the univariate analysis, each OCT-A parameter showed a statistically significant correlation with exudation on structural OCT (p<0.001). The overall analysis demonstrated a sensitivity of 96.7% and a positive predictive value of 87.9%. In the multivariate analysis, a model with four criteria predicted an exudative lesion in 97.6% of cases and one with two criteria (tiny branching vessels and peripheral anastomotic arcades) in 71.2%.

Conclusions The presence of tiny branching vessels and a peripheral anastomotic arcade appears to predict the lesion activity with a good accuracy and the model based on four criteria enables optimal decisions regarding retreatment in eAMD.

  • AMD, age-related macular degeneration
  • exudative-AMD
  • choroidal neovascularisation
  • optical coherence tomography angiography
  • OCT angiography
  • predictive model
  • structuralOCT

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/bjophthalmol-2018-313065

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    Footnotes

    • FC and ML are joint first authors.

    • FC and ML contributed equally.

    • Contributors FC and ML provided a substantial contribution to the conception of the work, to the acquisition, analysis and interpretation of data, in drafting the manuscript and in giving the final approval of the submitted study. FC and ML equally contributed to the manuscript and may be both considered as firs author. JFB, AS, DC, RS and CF contributed to the acquisition, analysis and interpretation of data and gave the final approval of the submitted study. EHS and GC provided a substantial contribution in the conception of the work, in drafting the manuscript and gave the final approval of the submitted study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Paris Institutional Ethics Committees (IEC).

    • Provenance and peer review Not commissioned; externally peer reviewed.