Faatz Henrik, Rothaus Kai, Gunnemann Frederic, Gutfleisch Matthias, Heimes-Bussmann Britta, Lommatzsch Albrecht, Pauleikhoff Daniel, Farecki Marie-Louise
Retinologie, Augenzentrum am St. Franziskus-Hospital, Münster.
Zentrum für Augenheilkunde, Universität Duisburg-Essen, Essen.
Klin Monbl Augenheilkd. 2017 Sep;234(9):1125-1131. doi: 10.1055/s-0043-118346. Epub 2017 Sep 11.
OCT-A is a new method to visualise the 2D and 3D structures of neovascular complexes in exudative AMD. The aim of the present study was to characterise type 2 CNV in different 2D segmentations and in 3D imaging and to investigate changes during anti-VEGF treatment. 12 patients with type 2 CNV in FA and SD-OCT were selected. OCT-A (Avanti, Optovue) was obtained initially and after the first three injections and thereafter, if "new activity" (increase in sub- or intraretinal fluid) occurred. The characteristics of the type 2 CNV were classified initially and during follow-up in different segmentations (outer retina, RPE, CC, choroidea), in respect to the size of the CNV, the flow area within the CNV and flow index (% of flow area within the total lesion). Comparison of the vessel characteristics before and after anti-VEGF treatment showed a significant reduction in the size of CNV at every level (p < 0.05). This was most significant at the RPE level (p < 0.005). After new activity, a significant increase in size was only recognised at the CC level (p < 0.05). Similarly, the most significant changes in the flow area were measured at the RPE level before and after treatment (p < 0.01) and at the CC level after new activity (p < 0.05). Demarcation from type 2 CNV of the bordering tissue was much better when activity occurred. OCT-A provides a new opportunity for the assessment of vascular characteristics of type 2 CNV, and quantifies CNV size and vascularisation under anti-VEGF therapy. This may be used in further studies in combination with SD-OCT scans to describe characteristics of this type of CNV under treatment. OCT-A is an additional medical imaging procedure to SD-OCT and FA, but more experience is needed in distinguishing CNV in the active and non-active stages.
光学相干断层扫描血管造影（OCT-A）是一种用于可视化渗出性年龄相关性黄斑变性（AMD）中新生血管复合体二维和三维结构的新方法。本研究的目的是在不同的二维分割和三维成像中对2型脉络膜新生血管（CNV）进行特征描述，并研究抗血管内皮生长因子（VEGF）治疗期间的变化。选择了12例在荧光素血管造影（FA）和光谱域光学相干断层扫描（SD-OCT）中表现为2型CNV的患者。最初、在前三次注射后以及此后如果出现“新活动”（视网膜下或视网膜内液体积聚增加）时，均进行OCT-A（Avanti，Optovue）检查。在不同的分割（外层视网膜、视网膜色素上皮（RPE）、脉络膜毛细血管（CC）、脉络膜）中，根据CNV的大小、CNV内的血流面积和血流指数（总病变内血流面积的百分比），对2型CNV的特征进行初始分类和随访期间的分类。抗VEGF治疗前后血管特征的比较显示，各个层面的CNV大小均显著减小（p < 0.05）。这在RPE层面最为显著（p < 0.005）。出现新活动后，仅在CC层面观察到大小显著增加（p < 0.05）。同样，治疗前后在RPE层面测量到的血流面积变化最为显著（p < 0.01），出现新活动后在CC层面也有显著变化（p < 0.05）。当出现活动时，与相邻组织的2型CNV的界限划分得更好。OCT-A为评估2型CNV的血管特征提供了新机会，并对抗VEGF治疗下的CNV大小和血管化进行量化。这可用于进一步研究，结合SD-OCT扫描来描述这种类型的CNV在治疗中的特征。OCT-A是SD-OCT和FA之外的一种医学成像检查方法，但在区分活跃期和非活跃期的CNV方面还需要更多经验。
