Spectral-domain OCT in anti-VEGF treatment of myopic choroidal neovascularization

Purpose To evaluate changes in macular morphology due to myopic choroidal neovascularization (CNV), using spectral-domain optical coherence tomography (SD-OCT). Methods In all, 22 eyes with recent-onset untreated CNV underwent 1 intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), followed by a pro-re-nata regimen. SD-OCT was performed at baseline (before first administration of anti-VEGF treatment) and month 1, and 2; macular morphologic changes and outer retina characteristics (SD-OCT findings) associated with CNV activity were evaluated. Sensitivity and specificity were calculated for SD-OCT findings using fluorescein angiography (FA) as standard reference. Results Mean central retinal thickness (CRT) showed no significant reduction from baseline (284 +/- 98 mu m) to month 1 (257 +/- 74 mu m) and month 2 (263 +/- 72 mu m). A hyper-reflective lesion with fuzzy borders (fuzzy area), and 'absent or altered' IS/OS junction were the only SD-OCT findings associated with CNV activity (P<0.0001). Both these SD-OCT findings showed good sensitivity and specificity (95.1 and 96.0% (95% CI: 0.87-0.89), respectively, for the fuzzy area; 87.9 and 66.7% (95% CI: 0.65-0.87), respectively, for 'absent or altered' IS/OS junction) when compared with FA leakage (standard reference). Conclusions Outer retina characteristics (ie, hyper-reflective lesion with fuzzy borders, and 'absent or altered' IS/OS junction) appear more meaningful than CRT in the evaluation of myopic CNV activity. These SD-OCT findings show overall good sensitivity and specificity when compared with FA leakage (standard reference), and could be considered as an alternative diagnostic tool to FA for myopic CNV monitoring. Eye (2012) 26, 976-982; doi:10.1038/eye.2012.75; published online 27 April 2012