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. 1999 Apr;83(4):438–442. doi: 10.1136/bjo.83.4.438

OCT imaging of choroidal neovascularisation and its role in the determination of patients' eligibility for surgery

A Giovannini 1, G Amato 1, C Mariotti 1, B Scassellati-Sforz 1
PMCID: PMC1722999  PMID: 10434866

Abstract

AIM—To evaluate the optical coherence tomographic characteristics of choroidal neovascularisation (CNV) in age related macular degeneration (AMD) and in idiopathic and inflammatory CNV. The use of this technique in the selection of patients for surgery is discussed.
METHODS—Ocular coherence tomography (OCT), fluorescein, and indocyanine green angiography were performed in 23 patients affected by AMD complicated by well defined CNV and in 10 patients affected by inflammatory or idiopathic CNV. The neovascular membrane was surgically removed in five age related CNVs, two inflammatory choroidopathies, and two idiopathic CNVs.
RESULTS—In inflammatory and idiopathic CNV, the OCT displayed a neovascularisation on the retinal pigment epithelium (RPE). In three cases the CNV was excised with an improvement of visual acuity equal to or greater than two Snellen lines; in a fourth case, the visual acuity after surgery was unchanged. In the cases of AMD the OCT fell into three different patterns: (A) CNV above the RPE (five cases); (B) focal, irregular thickening of the retinal pigment epithelial band (12 cases); (C) CNV above and below the RPE (six cases). The five pattern A CNV patients underwent the surgical excision of the neovascularisation. In four cases the visual acuity improved by two or more Snellen lines; in the fifth case the visual acuity remained unchanged.
CONCLUSIONS—The authors suggest that the surgical removal of early age related CNV could be performed in those cases where the OCT shows a neovascular membrane on the RPE, as in idiopathic and inflammatory CNVs.

 Keywords: age related macular degeneration; choroidal neovascularisation; optical coherence tomography; vitreoretinal surgery

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Figure 1  .

Figure 1  

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(A) Fluorescein angiogram shows an idiopathic subfoveal CNV in a 34 year old woman. (The broken line on FA frame indicates the OCT scan direction). (B) The OCT shows a marked thickening (481 µm) of the neurosensory retina corresponding to the CNV. The CNV can be identified as an area of hyperreflectivity lying above the band corresponding to the RPE.

Figure 2  .

Figure 2  

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Multifocal choroidopathy. The OCT displays a focal hyperreflectivity lying above the RPE corresponding to the CNV (small arrows); at the same site of the atrophic spot a deep hyperreflectivity can be detected (large arrows).

Figure 3  .

Figure 3  

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Multifocal choroidopathy. (A) Fluorescein angiography before surgery (VA= 20/40). (The broken line on FA frame indicates the OCT scan direction). (B) OCT before surgery: the neurosensory thickness is 475 µm; a focal hyperreflectivity lying above the band corresponding to the RPE can be visualised. (C) Fluorescein angiography after surgery (VA= 20/30): the CNV has been completely removed. (The broken line on FA frame indicates the OCT scan direction). (D) OCT after surgery: the normal foveal profile is restored and retinal thickness is 160 µm. The hyperreflectivity interpreted as the CNV is no longer visible.

Figure 4  .

Figure 4  

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AMD complicated by CNV (OCT pattern A). (A) Fluorescein angiography shows a juxtafoveal and a peripapillary CNV. (The broken line on FA frame indicates the OCT scan direction). (B) The OCT scan performed through the juxtafoveal CNV reveals a marked thickening (503 µm) of the neurosensory retina and an increased reflectivity above the RPE interpreted as the CNV. A thin optically empty space, signifying neurosensory detachment, surrounds the CNV.

Figure 5  .

Figure 5  

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AMD complicated by CNV (OCT pattern B). The OCT shows a focal, irregular thickening of the band corresponding to the RPE, that appears fragmented and disorganised.

Figure 6  .

Figure 6  

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AMD complicated by CNV (OCT pattern C). An irregular hyperreflectivity can be visualised both above and below the level of the band corresponding to the RPE. The retinal pigment epithelial band presents a focal duplication.

Figure 7  .

Figure 7  

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AMD complicated by subfoveal CNV. (A) Fluorescein angiography before surgery (VA=20/200). (The broken line on FA frame indicates the OCT scan direction). (B) The OCT clearly displays a focal hyperreflectivity lying above the RPE interpreted as the CNV. In this case the OCT shows the relation between CNV and the centre of the fovea. The adjacent neuroretina presents a non-homogeneous, reduced, hyperreflectivity due to oedema. The retinal thickness is 379 µm. (C) Fluorescein angiography after surgery (VA= 20/60). The loss of retinal pigment epithelial cells and choriocapillaris is minimal. (The broken line on FA frame indicates the OCT scan direction). (D) The focal hyperreflectivity identified by OCT before surgery is no longer visible. The retinal thickness is 154 µm.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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