Abstract
Purpose
Compared with fluorescein angiography (FA), the gold standard for diagnosing choroidal neovascularization (CNV) activity, optical coherence tomography angiography (OCTA) is non-invasive without risks associated with fluorescein dye use, and may be especially advantageous in the diagnosis and monitoring of children with CNV.
Methods
Eight eyes from eight patients aged 12 months to 18 years were imaged with the investigational Spectralis OCTA (version 6.9, Heidelberg Engineering, Heidelberg, Germany) and the RTVue XR Avanti (Optovue Inc., Fremont, CA, USA). Two patients were imaged during examination under anesthesia while six patients were imaged in the clinic. Demographic information, ocular characteristics, treatment history, and imaging studies (color photos, fluorescein angiography, OCT) were collected and reviewed.
Results
Three eyes had active CNV while five had quiescent CNV at the time of imaging. CNV was idiopathic or secondary to trauma, retinal vascular dysgenesis versus retinopathy of prematurity, pigmentary retinopathy, Best vitelliform macular dystrophy, panuveitis, morning glory disc anomaly, and optic disc drusen. OCTA of two active CNV demonstrated presence of a main trunk with multiple fine capillaries, vessel loops, and anastomoses. OCTA was repeated after treatment for two CNV and demonstrated a decrease in size with loss of fine capillaries, vessel loops, and anastomoses. For the third active CNV, OCTA verified flow in the CNV complex despite the uncertainty of FA hyperfluorescence in the setting of grossly abnormal retinal vasculature. The five quiescent CNV all lacked fine capillaries, vessel loops, and anastomoses on OCTA.
Conclusion
OCTA demonstrates morphological differences between active and quiescent pediatric CNV.
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Funding
This study was funded by the International Association of Government Officials (iGO) Fund, Knights Templar Eye Foundation, Research to Prevent Blindness Unrestricted Grant to Duke Eye Center, NIH RO1 EY25009, NIH P30 EY005722 (Duke Eye Center Core Grant), Research equipment (Spectralis tabletop and Flex module), and grant provided by Heidelberg Engineering.
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DG has received research grants from Alimera Sciences and Allergan. JFA holds a patent from Springer SBM LLC; is a consultant for Turing Pharmaceuticals LLC, DORC International B.V., Allergan Inc., Bayer, and Mallinckrodt; and has received research grants from TOPCON. MAE has received research grants from the Knights Templar Eye Foundation. CAT receives royalties from Alcon and has received a research grant from NIH (RO1 EY25009). LV receives research grants from Janssen Pharmaceutical, Roche, DORC, Second Sight, Alcon, Genentech, B&L, and Alimera Sciences. STH declares that she has no conflict of interest. SSO declares that she has no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Duke University and Johns Hopkins University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
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Informed consent was obtained from all individual participants included in the study from Duke University. One participant was retrospectively included from Johns Hopkins University and no consent was obtained from this single case report.
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Ong, S.S., Hsu, S.T., Grewal, D. et al. Appearance of pediatric choroidal neovascular membranes on optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 258, 89–98 (2020). https://doi.org/10.1007/s00417-019-04535-4
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DOI: https://doi.org/10.1007/s00417-019-04535-4