Oct-SD Versus Fluorescein Angiography For Evaluation Of Exudative Features In Wet Age-related Macular Degeneration

Purpose:Imaging for evaluation of exudative signs in wet age-related macular degeneration (AMD) can be performed either on optical coherence tomography (OCT), fluorescein angiography (FA), or both. This study compares and analyzes OCT versus with FA exudative features in 117 eyes of 106 patients, during ranibizumab therapy in exudative AMD. Our purpose was to investigate whether examination with Spectral Domain OCT (SD-OCT) alone is sufficient to ascertain the need of re-treatment with ranibizumab in exudative AMD or if FA is needed. Methods:Retrospective, comparative study of 106 patients (117 eyes) with exudative AMD including 50 occult choroidal neovascularisation (type 1), 22 polypoidal choroidal vasculopathy (PCV), 23 chorioretinal anastomosis (CRA) and 22 classic choroidal neovascularisation (type 2). All cases were selected after the 6 first months of treatment by ranibizumab. SD-OCT and FA (Spectralis HRA-OCT Heidelberg Engineering, Heidelberg, Germany) were analyzed retrospectively and separately by 2 different experts (double reading). SD-OCT criteria for judgment of persistence of activity of the lesion were presence of any fluid, macular edema. FA criterion for judgment of persistence of activity of the lesion was leakage on late phases. The results of both imaging were compared in all sub-groups of wet AMD. Results:The mean age was 76,6 years; 29.8% were male, 70,2% female. In total among 117 eyes there was a 16,2 % conflict (19/117) between OCT and AF features. The divergence between FA and OCT was observed in 16% (8/50) of type 1, in 4.5 % (1/22) of CRA, in 4.3% (1/23) of PVC and in 50 % (11/22) of type 2 cases. Conclusions:Several studies demonstrated advantage of OCT-SD in detecting minor structural changes (cystoid macular edema, subretinal fluid, retinal pigment epithelium detachment increase, photoreceptor atrophy···). Our study shows the complementarities of these two imaging approaches. We suggest that FA should be performed on a regular basis in the follow-up of exudative AMD patients treated by anti-VEGF, particularly for type 2 CNV.