Microvasculature changes of mCNV after ranibizumab treatment using OCTA
Reviewed by Sofia Rokerya

In this study the authors aim to evaluate the vascular changes of myopic choroidal neovascularisation (mCNV) after ranibizumab treatment using optical coherence tomography-angiography (OCTA). The 3×3 OCTA en face images were analysed for the absence / presence of mCNV, CNV area, and CNV network morphology. In particular, the morphology of the mCNV was analysed to detect the presence / absence of feeder vessels. This prospective study included 11 patients (four male patients and seven female patients) with a mean age of 65.45 ±SD years (range 58-79 years). The mean spherical equivalent was –16.27 ±7.13dpt and mean axial length was 30.38 ±1.91mm. Five of 11 eyes (45%) were pseudophakic and 6/11 (55%) were phakic. Five patients had naïve mCNV and six patients had recurrent mCNV; the mCNV was subfoveal in 55% of cases and juxtafoveal in 45%. Mean baseline BCVA was 67.73 ±11.19 letters and changed to 71.55 ±8.52 letters at the six-month examination (t=1.05, p=0.317;). The mean central retinal thickness value at baseline was 384.00 ±76.63µm and decreased to 346.09 ±68.81µm at the six-month visit (t=1.89, p=0.088). During the study a mean number of 1.36±0.67 injections (range one to three) was administered. At six months, the mean mCNV area was not statistically significantly reduced in comparison with baseline values (p>0.05), while the morphologic analysis revealed a complete disappearance of the feeder vessel in six eyes. The subgroup analysis of these latter eyes showed that the CNV area was significantly reduced, visual acuity had improved, and only one intravitreal injection was administrated over the entire follow-up period. The study provided evidence of the efficacy of anti-VEGF therapy in the vascular remodelling of the mCNV with a reduction in the lesion area and in the presence of anastomoses, vascular loops, small capillary ramifications, and feeder vessels. In particular, the closure of the feeder vessel seems to play a role as a good prognostic factor. OCTA is a new tool and provides useful and additional information; however its precise role needs further development. Limitations: Small cohort, absence of monthly monitoring to evaluate temporal changes, non- application of available nomenclature and categorisation limits comparison with published data.

Microvasculature changes of myopic choroidal neovascularization and the predictive value of feeder vessel disappearance after ranibizumab treatment revealed using optical coherence tomography angiography.
Giorno P, Iacono P, Scarinci F, et al.
OPHTHALMOLOGICA
2020;243:263-70.