Author: Eliana Costanzo (Italy)
Co-authors: Mariacristina Parravano, Daniela Giannini, Enrico Borrelli, Riccardo Sacconi, Monica Varano, Giuseppe Querques
To explore the influence of optical coherence tomography (OCT) and OCT angiography (OCTA) parameters on the final lesion’s activity, in treatment-naïve type 1 macular neovascularization (MNV) eyes treated with a 1-year fixed regimen of intravitreal aflibercept injections (q8IAI).
This observational study was conducted at IRCCS-Fondazione Bietti of Rome, Italy.
Patients received a complete ophthalmological examination, which included the measurement of best corrected visual acuity (BCVA), intraocular pressure, and dilated fundus examination. All patients were imaged by Spectral Domain (SD-)OCT to evaluate central macular thickness (CMT), subretinal fluid (SRF), subretinal hyperreflective material (SHRM), intraretinal fluid (IRF) and intraretinal hyperreflective dots (HRD) and by Swept Source (SS-)OCTA to measure baseline MNV area, perfusion density (PD), vessel length density (VLD) and vessel diameter index (VDI) in the retinal pigment epithelium (RPE)-RPE fit scan. At the end of q8IAI, patients were classified in two groups: active-MNV (A-MNV) and inactive-MNV (I-MNV), considering the OCT signs of activity. SD-OCT and SS-OCTA parameters at baseline and their influence on lesion’s activity 1 month after the end of q8IAI, were analyzed. Three binary logistic regression models were developed: 1) OCT-based, 2) OCTA-based, 3) OCT/OCTA-based model. The models’ performance to distinguish between active and inactive groups was measured by the receiver operating characteristic (ROC) analysis with the area under the curve (AUC).
Thirty-one treatment-naïve type 1 MNV were enrolled (13 A-MNV and 18 I-MNV). No differences were observed in baseline OCT and OCTA characteristics between A-MNV and I-MNV. In the first model we explored the combination of OCT parameters (CMT, SRF, IRF, HRD and SHRM) as predictive factors for final lesion activity. In a second model we explored the combination of OCTA parameters (MNV Area, PD and VLD), excluding the VDI for a potential collinearity problem. In a third model we combined parameters of models 1 and 2 (OCT+OCTA). The model 1 and 3 showed a significant AUC (p = 0.013 for model 1 and p <0.001 for model 3), in the model 2 the AUC was not statistically significant p=0.088. Combining OCT and OCTA parameters a significant improvement of model performance was observed. The A-MNV group showed at baseline the presence of SRF, greater CMT, wider area of MNV on OCTA scans and lower PD and VLD compared to I-MNV.
In this study we analyzed the predictive value of baseline OCT and OCTA parameters in treatment-naïve type 1 MNV treated with q8IAI, using statistical logistic regression models. Our study demonstrated that the combination of baseline OCT and OCTA parameters allowed to achieve a good models’ performance in the prediction of MNV activity permitting to correctly classifying the active lesions at the end of follow-up period, with excellent sensitivity. By the analysis of the models, the presence of SRF, great CMT, large MNV area and low PD and VLD represent predictive baseline biomarkers for lesion’s activity after 1-year treatment in type 1 MNV.
Mariacristina Parravano has the following disclosures: Allergan (S), Bayer (S), Novartis (S). Monica Varano has the following disclosures: Allergan (S), Bayer (S), Novartis (S), SIFI (S) Giuseppe Querques has the following disclosures: ALLERGAN (S), ALIMERA (S), AMGEN (S), BAYER (S), KHB (S), NOVARTIS (S), ROCHE (S), SANDOZ (S), ZEISS (S). ALLERGAN (C), ALIMERA (C), BAUSCH AND LOMB (C), BAYER (C), HEIDELBERG (C), NOVARTIS (C), ZEISS (C). The other authors have nothing to disclose.