Non ICGA treatment criteria for Suboptimal Anti VEGF Response for Polypoidal Choroidal Vasculopathy: APOIS PCV Workgroup Report 2

Kelvin Yi Chong Teo, Srinivas R Sadda, Chui Ming Gemmy Cheung, Usha Chakravarthy, Giovanni Staurenghi, Alessandro Invernizzi, Yuichiro Ogura, Paisan Ruamviboonsuk, Shih-Jen Chen, Vishali Gupta, Colin Tan, Jay Chhablani, Federico Corvi, Judy E Kim, Fumi Gomi, Adrian H Koh, Gregg Kokame, Paul Mitchell, Tien Y Wong, Won Ki LeeTimothy Y Y Lai

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
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Abstract

Purpose
To develop and validate OCT and color fundus photography (CFP) criteria in differentiating polypoidal choroidal vasculopathy (PCV) from typical neovascular age-related macular degeneration (nAMD) in eyes with suboptimal response to anti–vascular endothelial growth factor (VEGF) monotherapy and to determine whether OCT alone can be used to guide photodynamic therapy (PDT) treatment.

Design
Clinical study evaluating diagnostic accuracy.

Participants
Patients with nAMD who received 3-month anti-VEGF monotherapy but had persistent activity defined as subretinal fluid or intraretinal fluid at month 3 assessments.

Methods
In phase 1, international retina experts evaluated OCT and CFP of eyes with nAMD to identify the presence or absence of features due to PCV. The performance of individual and combinations of these features were compared with ICGA. In phase 2, these criteria were applied to an independent image set to assess generalizability. In a separate exercise, retinal experts drew proposed PDT treatment spots using only OCT and near-infrared (NIR) images in eyes with PCV and persistent activity. The location and size of proposed spot were compared with ICGA to determine the extent of coverage of polypoidal lesions (PLs) and branching neovascular network (BNN).

Main Outcome Measures
Sensitivity and specificity of CFP and OCT criteria to differentiate PCV from nAMD and accuracy of coverage of OCT-guided PDT compared with ICGA.

Results
In eyes with persistent activity, the combination of 3 non–ICGA-based criteria (sharp-peaked pigment epithelial detachment [PED], subretinal pigment epithelium [RPE] ring-like lesion, and orange nodule) to detect PCV showed good agreement compared with ICGA, with an area under the receiver operating characteristic curve of 0.85. Validation using both an independent image set and assessors achieved an accuracy of 0.77. Compared with ICGA, the OCT-guided PDT treatment spot covered 100% of PL and 90% of the BNN.

Conclusions
In nAMD eyes with persistent activity, OCT and CFP can differentiate PCV from typical nAMD, which may allow the option of adjunct PDT treatment. Furthermore, OCT alone can be used to plan adjunct PDT treatment without the need for ICGA, with consistent and complete coverage of PL.
Original languageEnglish
Pages (from-to)945-953
JournalOpthalmology Retina
Volume5
Issue number10
Early online date16 Apr 2021
DOIs
Publication statusPublished - Oct 2021

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