Multimodal imaging and diagnosis of myopic choroidal neovascularization in Caucasians

Abstract

Purpose: To investigate myopic choroidal neovascularization (mCNV) by fluorescein angiography (FA), spectral-domain optical coherence tomography (SD-OCT), near-infrared (NIR) reflectance, and autofluorescence (AF).

Methods: This retrospective study included 65 eyes of 62 Caucasian patients with a mean age of 66.72 years (95% confidence interval [CI] 63-70 years) and a mean refraction of -9.72 diopters (95% CI -8.74 to -10.70 diopters).

Results: Most of the mCNV cases were foveal-juxtafoveal (60/65, 92.3%), with thickening of the corresponding retina (62/65, 95.3%) and leakage on FA (44/65, 67.6%). No retinal fluid was detectable in 32 (49.2%) eyes and there was no hemorrhage in 25 (38.4%) eyes. Papillary chorioretinal atrophy was evident in 58 (89.2%), a shadowing effect in 48 (73.8%), and an epiretinal membrane in 38 (58.4%) eyes. If an area of macular chorioretinal atrophy was present, mCNV frequently developed adjacent to it and was hyperfluorescent rather than with leakage (P⩽0.001). In eyes with edema or hemorrhage, hyper-reflective foci were more frequent (P⩽0.005). NIR and AF features were indeterminable in 19 (29.2%) and 27 (41.5%) eyes, respectively. The predominant feature was black or grayish on NIR (34/65, 52.3%) and patchy (hypo- and hyperfluorescence was observed) on AF (25/65, 38.4%). FA and SD-OCT correctly detected mCNV in 49 (75.3%) and 48 (73.8%) eyes, respectively, whereas NIR and AF exhibited limited diagnostic sensitivity. Doubtful diagnosis was associated with hyperfluorescent mCNV (P⩽0.001), absence of retinal fluid and epiretinal membrane (P⩽0.05), and presence of macular chorioretinal atrophy (P⩽0.01).

Conclusion: Tomographic, angiographic, AF, and NIR features of mCNV are described in this study. Combination of SD-OCT and FA is recommendable for diagnosis.

Keywords: CNV; SD-OCT; fluorescein angiography; imaging; myopic neovascularization; pathologic myopia.

Figure 1

Macular images of the right eye of a 50-year-old man with new-onset foveal myopic choroidal neovascularization (refractive error, 10 diopters). Notes: On autofluorescence (A), the lesion appeared hypoautofluorescent, circumscribed by a hyperautofluorescent ring (red arrowhead). Early (B) and late (C) fluorescein angiography frames show a hyperfluorescent lesion with late leakage (white arrowhead). Horizontal (D and E) and vertical (F and G) SD-OCT scans through the lesion show a hyper-reflective lesion with thickening of the corresponding retina (blue arrow), epiretinal membrane (green arrowhead), shadowing effect toward the choroid (yellow arrowhead in image E), and limited serous neuroretinal detachment (red circle). The white arrow in image F shows the position and the direction of the SD-OCT scan. Neovascularization was diagnosed on the basis of SD-OCT or fluorescein angiography findings, but not on the basis of autofluorescence or near-infrared imaging. Abbreviation: SD-OCT, spectral-domain optical coherence tomography.