Session Title: Free Paper Session 4: AMD II
Session Date/Time: Thursday 07/09/2017 | 11:00-12:30
Paper Time: 11:18
Venue: Room 111
First Author: : N.Sacha SWITZERLAND
Co Author(s): : A. Ambresin I. Mantel C. Bergin
Fluid on structural B scan OCT is currently the most important sign among all imaging modalities to diagnose and follow neovascular AMD. OCT-Angiography is now also widely performed in retinal community in clinical practice. Recently, OCT-Angiography biomarkers of activity of nAMD have been published. The aim of the study is to compare the appearance of OCT-Angiography of eyes with wAMD with intraretinal fluid against those with subretinal fluid.
Retrospective cross sectional study performed in the medical retina unit of the Jules Gonin Hospital.
The medical files of the Jules-Gonin eye hospital were reviewed to collect the following data: age and gender, ocular history, the number of preceding injections in the same eye, type of anti-VEGF injection agent and treatment interval. Fluid on Bscan OCT was classified as intraretinal fluid such as cysts and subretinal fluid as fluid under the retina. OCT-Angiography biomarkers of activity of nAMD were presence of secondary small vessel branching, peripheral arcades with anastomoses and presence of a dense net (DN). Inclusion criteria were presence of neovessels on OCT-Angiography images recognized by two independent retinal specialists and images quality on both structural and OCT-Angiography images. Presence of degenerative intraretinal cysts with underlying geographic atrophy or PED precluding the visualization of the underneath vascularization were exclusion criteria. Degenerative cysts were defined as unresponsive cysts despite continuous antiVEGF treatment over the last three monthly visits.
59 eyes of 55 patients treated for wet AMD were included in the study (average age: 80 (SD ±7), min-max: 63-95). The average CRT in controlled eyes (absence of fluid) was 320(±78) microns, whereas in uncontrolled eyes (presence of any fluid) mean CRT was 266 ±49 microns (p=0.002, Wilcoxon non paired test). Subretinal fluid was present in 20% eyes (12/59), intraretinal fluid in 25% (15/59), a combination of both in 10% (6/59) and absence of subretinal or intraretinal fluid in 44% (26/59). DN was present in 30% (18/59) whereas a loose net in 69% (41/59). Dense net was present in statistically significantly more of the uncontrolled eyes 45% (15/33) (p=0.009, fisher exact test.) Peripheral arcades with anastomoses were evident in 46% (12/26) of controlled eyes and 61% (20/33) of uncontrolled eyes. Secondary small vessel branching was evident in 0% (0/26) of the controlled eyes and in 36% (12/33) uncontrolled eyes. Atrophy was present in 38% (10/26) of controlled eyes, 60% (9/15) of eyes with only intra retinal fluid but there was no atrophy in eyes with any subretinal fluid (0%, 0/18).
Dense net is significantly more prevalent in eyes with uncontrolled AMD. These results suggest that OCT-A provides imaging of the morphology of the choroidal neovascularization in AMD patients is associated with disease activity.