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Longitudinal assessment of type 3 macular neovascularization using 3D volume-rendering OCTA

      Abstract

      Objective

      To investigate the evolution of treatment-naive type 3 macular neovascularization (MNV) undergoing anti-vascular endothelial growth factor (VEGF) treatment through volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA).

      Design

      Retrospective observational study.

      Participants

      Patients with type 3 MNV and age-related macular degeneration (AMD).

      Methods

      Included subjects had three loading injections of an anti-VEGF agent. The OCTA volume data at baseline and follow-up were processed with a previously published algorithm in order to obtain a volume-rendered representation of type 3 MNV. Progressive changes in type 3 lesions were analyzed via 3D OCTA volume rendering.

      Results

      A total of 14 treatment-naive eyes with type 3 MNV from 11 AMD patients (7 females) were included. At both baseline and follow-up visits, a type 3 MNV complex was identifiable. Each complex was composed of a mean number of 2.5 ± 0.7 vascular branches at baseline and 1.4 ± 0.6 at the follow-up visit (p < 0.0001). The mean changes in central macular thickness and visual acuity were significantly correlated with modifications in the number of type 3 MNV branches (ρ = –0.533, p = 0.049, and ρ = –0.581, and p = 0.040, respectively).

      Conclusions

      This study demonstrated that type 3 lesions do not disappear completely after loading treatment, as indicated previously by histopathologic studies. Importantly, quantitative volume changes in type 3 lesions are directly associated with treatment response.

      Résumé

      Objectif

      Examiner l’évolution d'une néovascularisation maculaire (NVM) de type 3 chez des patients qui n'ont jamais été traités et auxquels on administre un anti-VEGF (facteur de croissance endothélial vasculaire) grâce aux images obtenues à l'angiographie-tomographie par cohérence optique (OCTA) tridimensionnelle (3D) par le biais de rendu volumique.

      Nature

      Étude d'observation rétrospective.

      Participants

      Patients présentant une NVM de type 3 et une dégénérescence maculaire liée à l’âge (DMLA).

      Méthodes

      Les participants ont reçu 3 bolus d'un anti-VEGF. On a eu recours à un algorithme publié antérieurement pour manipuler les données de l'OCTA au départ et lors du suivi afin d'obtenir une représentation de la NVM de type 3 par le biais de rendu volumique. Les modifications progressives des lésions de type 3 ont été analysées grâce à l'OCTA en 3D par le biais de rendu volumique.

      Résultats

      Au total ont été inclus 14 yeux (11 patients qui avaient une DMLA, dont 7 femmes) qui présentaient une NVM de type 3 qui n'avait jamais été traitée. Il était possible d'identifier un complexe « NVM de type 3 » tant à la visite de départ qu’à celle de suivi. Chaque complexe comprenait un nombre moyen de 2,5 ± 0,7 branches vasculaires au départ et de 1,4 ± 0,6 lors de la visite de suivi (p < 0,0001). On a pu établir une corrélation significative entre la variation moyenne de l’épaisseur maculaire centrale et de l'acuité visuelle, d'une part, et les modifications du nombre de branches de NVM de type 3, d'autre part (p = –0,533; p = 0,049; p = –0,581 et p = 0,040, respectivement).

      Conclusions

      Notre étude a révélé que les lésions de type 3 ne disparaissent pas complètement après l'administration de bolus, comme le révélaient des études histopathologiques antérieures. Fait à noter, les variations quantitatives du volume des lésions de type 3 sont directement associées à la réponse thérapeutique.
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