COMBINED FLUORESCEIN ANGIOGRAPHY AND SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING OF CLASSIC CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION BEFORE AND AFTER INTRAVITREAL RANIBIZUMAB INJECTIONS


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Abstract

Purpose:To evaluate the combined fluorescein angiography and spectral-domain optical coherence tomography features in a consecutive series of exudative age-related macular degeneration eyes with classic choroidal neovascularization before and after anti–vascular endothelial growth factor treatment.Methods:Retrospective interventional study. All consecutive patients with exudative age-related macular degeneration because of newly diagnosed classic choroidal neovascularization visited during 3 months and treated by intravitreal ranibizumab injection on “as-needed” basis were analyzed. Combined fluorescein angiography and spectral-domain optical coherence tomography examination (Spectralis Heidelberg Retina Angiograph OCT) was performed at baseline and at the 12-month follow-up visit.Results:Twenty-nine treatment-naive eyes (29 patients, 10 men and 19 women, mean age 76.28 ± 10.86 years) were included. A mean of 5.3 ± 3.5 injections was administered during 12 months. At Month 12 visit, patients showed an improved best-corrected visual acuity (P = 0.01), a reduction of linear dimension of the entire lesion on fluorescein angiography (P = 0.02), and a reduction of the entire lesion width on spectral-domain optical coherence tomography (P < 0.001). At baseline, in all cases we distinguished on spectral-domain optical coherence tomography scan a highly reflective subretinal lesion, above and separate from the retinal pigment epithelium. The highly reflective subretinal lesion showed a significant reduction of width along the length of a single B-scan, at Month 12 follow-up visit (P < 0.001). It is notable that a small “discreet” pigment epithelial detachment associated with the highly reflective subretinal lesions was present in 28 of 29 eyes at baseline and after treatment (at Month 12 follow-up visit).Conclusion:A discreet pigment epithelial detachment represents a common associated finding of classic choroidal neovascularization. Our study demonstrated that anti–vascular endothelial growth factor treatment may not only stop the growth of the highly reflective subretinal lesion that colocalize with the classic choroidal neovascularization but also determine its regression.

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