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.

To characterize quantitative optical coherence tomography angiography (OCT-A) parameters in active neovascular age-related macular degeneration (nAMD) patients under treatment and remission nAMD patients. Retrospective, cross-sectional study. One hundred and four patients of whom 72 were in Group 1 (active nAMD) and 32 in Group 2 (remission nAMD) based on SD-OCT (Spectral Domain OCT) qualitative morphology. This study was conducted at the Centre Ophtalmologique de l’Odeon between June 2016 and December 2017. Eyes were analyzed using SD-OCT and high-speed (100 000 A-scans/second) 1050-nm wavelength swept-source OCT-A. Speckle noise removal and choroidal neovascularization (CNV) blood flow delineation were automatically performed. Quantitative parameters analyzed included blood flow area (Area), vessel density, fractal dimension (FD) and lacunarity. OCT-A image algorithms and graphical user interfaces were built as a unified tool in Matlab coding language. Generalized Additive Models were used to study the association between OCT-A parameters and nAMD remission on structural OCT. The models’ performance was assessed by the Akaike Information Criterion (AIC), Brier Score and by the area under the receiver operating characteristic curve (AUC). A p value of ≤ 0.05 was considered as statistically significant. Area, vessel density and FD were different (p<0.001) in the two groups. Regarding the association with CNV activity, Area alone had the highest AUC (AUC = 0.85; 95%CI: 0.77–0.93) followed by FD (AUC = 0.80; 95%CI: 0.71–0.88). Again, Area obtained the best values followed by FD in the AIC and Brier Score evaluations. The multivariate model that included both these variables attained the best performance considering all assessment criteria. Blood flow characteristics on OCT-A may be associated with exudative signs on structural OCT. In the future, analyses of OCT-A quantitative parameters could potentially help evaluate CNV activity status and to develop personalized treatment and follow-up cycles.

Aims To evaluate the long-term progression of quiescent type 1 choroidal neovascularisation (CNV) associated with age-related macular degeneration (AMD) or with pachychoroid disease. Methods All cases of quiescent type 1 CNV with a minimum follow-up of 12 months seen at the Department of Ophthalmology of University Paris Est, Creteil and at the Centre Ophtalmologique de l’Odeon, Paris, between June 2009 and December 2018 were retrospectively reviewed. Optical coherence tomography angiography (OCT-A) of eyes not showing CNV activation during 24 months was evaluated for quantitative analyses of CNV status biomarkers (fractal dimension, lacunarity, vessel density, aspect ratio, CNV area). Results A total of 67 eyes (65 patients, 43 females, mean age 76.63±9.7 years) with quiescent CNV and a mean follow-up of 49.56±27.3 (12–112) months were included. Of 28 eyes showing activation of quiescent CNV, 12 eyes with pachychoroid-associated CNV showed reduced visual loss (−3.28 ETDRS letters, p=0.7 vs −13.03 ETDRS letters, p=0.02), greater choroidal thinning (−59.5 µm, p=0.03 vs – 16.36 µm, p=0.3) and needed less antivascular endothelial growth factor intravitreal injections (IVI) (0.09 vs 0.21, p=0.01) than 16 eyes with AMD-associated CNV. CNV area was the only OCT-A biomarker to significantly change during 24 months in inactive quiescent CNV (+29.5%, p=0.01, in pachychoroid group and +27.1%, p=0.03, in the AMD group). Conclusion In the long-term follow-up, inactive quiescent CNV showed an increase of CNV area without significant changes of the other OCT-A biomarkers. Quiescent type 1 CNV undergoing activation showed greater response to IVI when associated to pachychoroid.

Purpose: To assess the long-term evolution of treatment-naive quiescent choroidal neovascularization (CNV), in age-related macular degeneration (AMD), to identify predictive activation biomarkers. Methods: Patients with quiescent CNV underwent a comprehensive ophthalmological examination, including fluorescein and indocyanine green angiographies, structural optical coherence tomography (OCT), and OCT angiography. Qualitative and quantitative analyses of structural OCT and OCT angiography images were performed during the study period. At the last follow-up evaluation, the enrolled eyes were divided into two groups: eyes with quiescent CNV converting to exudative AMD (eAMD) and those not progressing to eAMD. Results: Sixty-eight eyes of 68 patients were enrolled in the study. Mean follow-up duration was 40 ± 28 months using multimodal imaging and 22 ± 13 months using OCT angiography. On structural OCT, quiescent CNV not converting to eAMD showed a preferential growth of the pigment epithelium detachment greatest linear diameter (P = 0.009), whereas the eAMD group presented a preferential growth of the pigment epithelium detachment maximal height (P < 0.0001) during the study period. Quantitative analysis of choriocapillaris OCT angiograms confirmed the CNV area growth during follow-up (from 4.18 ± 4.77 mm² at baseline to 5.10 ± 5.06 mm² at the last follow-up visit; P = 0.02). Conclusion: A close follow-up is recommended to early identify predictive activation biomarkers of treatment-naive quiescent CNV.

To compare optical coherence tomography-angiography (OCT-A) performed during physical exercise (stress OCT-A) to the basal examination (rest OCT-A) in the imaging of choroidal neovascularization (CNV) in patients with chronic central serous chorioretinopathy (CSCR). Prospective, cohort study. This multicenter study included 29 consecutive patients with chronic CSCR and flat irregular pigment epithelium detachments (FIPEDs). All patients underwent rest and stress OCT-A (i.e., hand-grip test [HGT]). Systemic hemodynamic data were recorded during the examinations. Rest and stress OCT-A in the en-face and cross-sectional views were qualitatively compared to establish the degree of evidence of flow signals due to CNVs. The en-face angiograms underwent additional automated quantitative analysis to assess the rate of change in neovascular parameters during the stress condition. Blood pressure significantly increased during the HGT (P = 0.001). Considering both the en-face and the cross-sectional images, CNV was identified in 13 eyes with the rest OCT-A and in 22 eyes with the stress OCT-A (P = 0.001). Cross-sectional imaging was more sensitive than en-face imaging in detecting neovascular blood flow signals under both rest (P = 0.125) and stress (P = 0.001) conditions. The quantitative analysis showed a significantly greater neovascular area and fractal dimension on the stress OCT-A (P = 0.002). Performing OCT-A during HGT enhances the sensitivity of the examination in detecting CNV in chronic CSCR. The increased neovascular perfusion following the induced increase of blood pressure is consistent with choroidal blood flow dysregulation in patients with CSCR and indicates new areas of discussion about CNV in this disease.