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. 2022 Sep 8;58(9):1246.
doi: 10.3390/medicina58091246.

Undetectable Macular Neovascularization on OCT Angiography in Age Related Macular Degeneration: Comparison between Different Devices

Meryem Filali Ansary  1 , Emanuele Crincoli  1 , Oudy Semoun  1 , Joel Uzzan  1 , Francesca Amoroso  1 , Camille Jung  2 , Alexandra Miere  1 , Eric Souied  1
Affiliations

Undetectable Macular Neovascularization on OCT Angiography in Age Related Macular Degeneration: Comparison between Different Devices

Meryem Filali Ansary et al. Medicina (Kaunas). .

Abstract

Background and Objectives: The aim of this study was to report the characteristics of macular neovascularization (MNV) with undetectable flow on optical coherence tomography angiography (OCTA) in neovascular age related macular degeneration (nAMD), and compare them with the characteristics of detectable MNV. Materials and Methods: Patients with a diagnosis of nAMD who underwent dye imaging and OCTA in the same day were included and divided into two groups: undetectable and detectable flow on OCTA. Three OCTA devices were used, two with spectral-domain technology (AngioVue, RTVue 100xAvanti, Optovue, Freemont, CA, USA and Heidelberg OCT2 Beta Angiography Module, Heidelberg Engineering, Germany) and one swept-source OCTA (PlexElite 9000; Carl Zeiss Meditec, Inc., Dublin, CA, USA). We studied the demographics, neovascularization characteristics, and OCTA device and acquisition characteristics for both groups. Results: A global comparison between Group 1 and Group 2 was made, followed by an analysis of variables associated with (un)detectability for each OCTA device. A total of 108 eyes were included: 90 in the detectable group (Group 1) and 18 in the undetectable group (Group 2), corresponding to a global sensitivity of OCTA for the detection of MNV of 83.49%. There was a statistically significant difference between the two groups regarding MNV type (p = 0.02) and PED height (p = 0.017). For the three devices, detection sensitivity with automatic segmentation was significantly lower than with manual segmentation. For Heidelberg, PED Height and scan quality explained 68.3% of the undetectability. For AngioVue, PED Height and absence of hemorrhage explained 67.9% of undetectability. Conclusions: In this study, we found a global sensitivity of 83.49% for the three OCTA devices combined, with a range from 55.5% to 96.26% depending on the segmentation and OCTA device. This means that undetectable/undetected MNV can represent up to 45% of the examinations, eventually misdiagnosing choroidal neovascularization for 1 out every 2 patients.

Keywords: OCT-angiography (OCTA); macular neovascularization; optical coherence tomography (OCT); spectral-domain OCTA; swept-source OCTA.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) SD-OCT crossing through the lesion showing a fibrovascular pigment epithelial detachment (PED) with subretinal fluid. (B) Early indocyanine green angiography (ICGA). (C) Late ICGA with late hyperfluorescent plaque. (D) En face and cross-sectional 3 × 3 mm2 SD-OCTA with Heidelberg OCT2 RP fit manual segmentation showing no detectable flow. (E) En face and cross-sectional 3 × 3 mm2 SS-OCTA with PlexElite RPE-fit manual segmentation showing a distinct high flow network.
Figure 2
Figure 2
(A) SD-OCT crossing through the lesion showing a fibrovascular PED. (B) Early indocyanine green angiography. (C) Late indocyanine green angiography with late hyperfluorescent plaque. (D) En face and cross-sectional 3 × 3 mm2 SD-OCTA with ANgiovue automated segmentation showing no distinctable flow. (E) En face and cross-sectional 3 × 3 mm2 SD-OCTA with Angiovue corrected manual segmentation showing a distinct neovascular complex.
Figure 3
Figure 3
(A) SD-OCT crossing through the lesion showing a flattened irregular PED. (B) Early fluorescein angiography. (C) Late indocyanine green angiography with late hyperfluorescent plaque. (D) En face and cross-sectional 6 × 6 mm2 SS-OCTA with PleXelite MS Custom segmentation showing distinct flow overlay. (E) En face and cross-sectional 3 × 3 mm2 SD-OCTA with AngioVue corrected manual segmentation. (F) En face and cross-sectional 3 × 3 mm2 SD-OCTA with AngioVue automated segmentation showing no detectable flow.
Figure 4
Figure 4
(A) SD-OCT crossing through the lesion showing a flattened irregular PED with sub-retinal hyper-reflective material. (B) Early fluorescein angiography. (C) Late indocyanine green angiography with late hyperfluorescent plaque. (D) En face and cross-sectional 6 × 6 mm2 SD-OCTA with AngioVue automated segmentation showing no distinct detectable flow. (E) En face and cross-sectional 6 × 6 mm2 SD-OCTA with AngioVue corrected manual segmentation. (F) En face and cross-sectional 6 × 6 mm2 SS-OCTA with PlexElite MS Custom segmentation showing distinct flow overlay.
Figure 5
Figure 5
ROC curves for sensitivity and specificity of PED height in the prediction of MNV unpredictability with OCTA when measured with Heidelberg (left side) and Angiovue (right side) OCT B scan. OCT = optical coherence tomography; PED = pigment epithelial detachment; ROC = receiver operating characteristics curves.
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