Optical coherence tomography angiography (OCT-A) is effective in detecting active inflammatory choroidal neovascularization (iCNV) in heterogeneous uveitic etiologies and can be used as an adjunct to monitor treatment response, according to a study published in Retina.
Researchers conducted a retrospective review of patients diagnosed with uveitis and associated iCNV with active exudation. They used spectral domain-OCT or fluorescein angiogram to identify active iCNV, spectral domain-OCT-A outer retina to choriocapillaris (ORCC) slabs to determine the presence of iCNV, and performed qualitative assessment OCT-A images to determine whether regression of iCNV occurred following treatment.
Investigators evaluated 13 eyes of 12 patients (mean age, 49.2 years; age range, 14-72; 5 men, 7 women). Uveitis etiologies included punctate inner choroidopathy (n=4), multifocal choroiditis (n=2), presumed sarcoid uveitis (n=2), tuberculous choroiditis (n=1), birdshot chorioretinopathy (n=1), syphilitic uveitis (n=1), serpiginous choroiditis (n=1) and idiopathic panuveitis (n=1).
OCT-A detected iCNV in 10 of the 13 eyes (76.9%). After iCNV treatment, OCT-A showed a complete regression of iCNV in 5 of 10 eyes (50%), partial regression in 2 of 10 eyes (20%), and no regression in 3 of 10 eyes (30%). It even identified iCNV in 1 eye that had disease undetected by fluorescein angiogram which researchers say “may have been due to the small size of the iCNV and potential leakage obscured by staining of an adjacent inflammatory lesion.”
In 38% of the eyes reviewed, subretinal hyper-reflectivity (SRH) was the only presenting OCT feature of iCNV. The investigators explain that OCT-A may be the optimal tool for monitoring these cases in particular as “it is usually challenging to determine if the SRH on OCT is due to iCNV, scarring, or an inflammatory lesion.” However, OCT-A can detect most iCNV, even when SRH is the only presenting sign. This is particularly pertinent in monitoring patients already undergoing iCNV treatment since, as treatment shrinks the SRH area in iCNV, it can be difficult to determine if the iCNV is still active on fluorescein angiogram or OCT.
“OCT-A is a useful diagnostic tool for the identification of active iCNV secondary to different uveitic entities,” according to the investigators. Researchers note that OCT-A is not only valuable for its diagnostic abilities, it can also be used as an “adjunctive tool to monitor treatment response of iCNV, particularly in cases of borderline OCT findings.”
Limitations of the study included the retrospective design, a relatively short follow-up duration, and a small sample size.
Kongwattananon W, Grasic D, Lin H, Oyeniran E, Sen HN, Kodati S. The role of optical coherence tomography angiography in detecting and monitoring inflammatory choroidal neovascularization. Retina. Published online January 20, 2022. doi:10.1097/IAE.0000000000003420