Optical coherence tomography angiography of type 3 neovascularisation in age-related macular degeneration after antiangiogenic therapy.

Abstract

To assess the microvascular response of type 3 neovascularisation secondary to age-related macular degeneration (AMD) after antivascular endothelial growth factor (anti-VEGF) therapy using optical coherence tomography angiography (OCTA). Consecutive patients diagnosed with AMD and type 3 neovascularisation based on clinical examination, structural optical coherence tomography and fluorescein angiography when available were retrospectively evaluated. En face OCTA imaging (3×3 mm scans) with quantitative microvascular analysis was performed at baseline and after a single anti-VEGF intravitreal injection. 17 eyes of 14 patients underwent OCTA before and after anti-VEGF treatment. OCTA demonstrated significant regression of small calibre type 3 neovascular tufts in all eyes. Median lesion area was 0.061 mm² (range 0.003-0.198 mm²) at baseline and 0.009 mm² (range 0-0.085 mm², p=0.0003) at follow-up. Cystoid macular oedema and/or subretinal fluid resolved in all cases after treatment. The type 3 lesions became undetectable with OCTA post-treatment in 5 of the 17 eyes. However, in 11 eyes, large feeder vessels were identified and remained unchanged after treatment. The microvascular morphology of type 3 neovascularisation secondary to AMD was assessed at baseline and follow-up and showed significant regression in response to anti-VEGF therapy by OCTA. Quantitative OCTA analysis was also performed and confirmed remarkable regression in response to a single intravitreal anti-VEGF injection.