Researchers from South Korea have validated the TES protocol through the identification of OCT-A biomarkers that correspond with recurrent sustained exudation choroidal neovascularization (CNV).
OCT-A images were assessed at least 24 months after anti-VEGF treatment began, when the CNV lesion was stable. Bae et al. used OCT-A to identify CNV lesions through known patterns and forms: closed circuit, open circuit, peripheral loop, and capillary fringe.
Closed circuit was defined as the “presence of anastomotic vessel bounding the outer border of the vascular lesion for more than 50% of the entire CNV margin,” open circuit was defined as “anastomotic vessel for less than 50%,” peripheral loop was defined as “looping vessels in the periphery branching into vascular arcades between the vessel termini,” and capillary fringe was defined as “fine peripheral network or flush of vessels that were not individually resolved on OCTA.”
In the continuing treatment group, 37% of eyes had open-circuit patterns on the OCT-A, while 63% of eyes had closed-circuit patterns. In the stop group, 78% of eyes had open-circuit patterns, while only 22% of eyes had closed. CNV was not observed in 17 eyes in the stop treatment group. CNV patterns varied greatly across both groups. Capillary fringe and peripheral loop patterns were more common in the continuing treatment group than stop group (73.3% versus 45.4%, p = 0.002, and 88.7% versus. 11.3%, p < 0.001, respectively) and were associated with sustained neovascular activity.
Based on these observations, researchers concluded that the appearance of neovascularization can be used to determine if patients with neovascular AMD will respond to anti-VEGF therapy. They also concluded that TES is reasonable and discontinuing treatment possible.
Bae K, Kim HJ, Shin YK, Kang SW. Predictors of neovascular activity during neovascular age-related macular degeneration treatment based on optical coherence tomography angiography. Scientific reports 2019;9:19240.
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