Session Title: Free Paper Session 27: AMD VI
Session Date/Time: Sunday 10/09/2017 | 12:00-13:30
Paper Time: 12:54
Venue: Room 117
First Author: : O.Kousha UK
Co Author(s): : S. Pagliarini
Spectral-domain optical coherence tomography (SD-OCT) morphological features of choroidal neovascularization (CNV) include classical findings such as intra-retinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) and morphological features like subretinal hyper-reflective materials (SHRM) and intra-retinal flecks. Recognizing SHRM and flecks may allow prompt recognition of active neovascular age-related macular degeneration (nAMD) when classical features are unchanged or absent. We aimed to ascertain the role of SHRM and flecks in eyes actively treated for nAMD as predictor of the classical features of CNV activity in nAMD.
This study was carried out in a tertiary medical retina referral centre, University Hospitals Coventry and Warwickshire.
In this cross-sectional study, we assessed the two most recent Spectralis SD-OCT scans of eyes on treat and extend regime of intravitreal anti-vascular endothelial growth factor injection for nAMD. The OCT findings were divided into classical signs and morphological features of SHRM suggestive of CNV activity (intra-retinal flecks and lower reflectivity SHRM with undefined boundaries (LRUnDB)), stability (higher reflectivity SHRM with well-defined boundaries (HRWDB)) or ambivalent features like higher reflectivity SHRM with undefined boundaries (HRUnDB) or lower reflectivity SHRM with well-defined boundaries (LRWDB). The PED was subdivided into predominantly serous, fibrovascular (FV) or irregular shallow retinal pigment epithelial elevation (RPEE). Increased classical features of CNV activity was defined as increased IRF/SRF/Serous PED on point by point comparison with the previous OCT.
237 eyes (203 patients) were included in the study, 27 of which were in the loading phase. The prevalences were IRF 25%, SRF 37%,, serous PED 19%, FVPED 62%, RPEE 12%, flecks 31%, LRUnDB 18%, LRWDB 45%, HRUnDB 0.4% and HRWDB 9%. IRF and/or SRF and/or serous PED moderately correlated with Flecks and LRUnDB with correlation coefficient r = 0.49* and 0.40* respectively. Flecks and LRUnDB were negatively correlated with FVPED and/or RPEE; r = -0.44* and -0.39* respectively. Presence of flecks and LRUnDB was a strong predictor classical signs of increased CNV activity; odds ratio 3.31 (95% CI 1.87 - 4.17). In seven cases, LRUnDB was the the only initial sign with subsequent reactivation of nAMD. Increased IRF/SRF/Serous PED requiring change of management had significantly higher LRUnDB; 40% vs 10%, χ2 (1, n = 81) = 7.13, p-value <0.01. * = p-value <0.001
LRUnDB and flecks are common finding in nAMD, are correlated with increased CNV activity, and are good predictor of increased CNV activity. Therefore, based on the OCT findings, these eyes may be selected for more aggressive treatment.