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Die fibrovaskuläre Umwandlung der CNV bei nAMD unter lang andauernder Anti-VEGF-Therapie

Methodenevaluation zur Quantifizierung morphologischer Veränderungen

Fibrovascular transformation of CNV in nAMD after long-term anti-VEGF therapy

Methodological evaluation of quantifying morphological changes

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Zusammenfassung

Hintergrund

Bei der neovaskulären altersabhängiger Makuladegeneration (nAMD) kann es unter lang andauernder Anti-VEGF-Therapie zu einer fibrovaskulären Umwandlung der choroidalen Neovaskularisation (CNV) kommen. Es fehlen Definitionen, wie eine differenzierte Quantifizierung der einhergehenden morphologischen Veränderungen erfolgen kann. Die vorliegende Pilotstudie dient dem Ziel, die hierzu am besten geeigneten Bildgebungsmodalitäten zu definieren.

Patienten und Methode

Bei 56 Augen mit fibrosierter CNV nach min. 2 jähriger Anti-VEGF-Therapie und min. 12 intravitrealen Anti-VEGF-Injektionen wurden die folgenden Bildgebungsmodalitäten hinsichtlich der Abgrenzbarkeit von vaskulärem und fibrösem Anteil der CNV sowie von assoziierter Atrophie von retinalem Pigmentepithel (RPE) und Unterbrechung der ellipsoiden Zone (EZ) untersucht: Multicoloraufnahme (MC), Fundusautofluoreszenz (FAF), Fluoreszeinangiographie (FA) und Indocyaningrünangiographie (ICGA), Spectral-domain-optische Kohärenztomographie (SD-OCT) und OCT-Angiographie (OCTA).

Ergebnisse

Der vaskuläre Anteil der fibrosierten CNV konnte am besten mittels OCTA, der fibröse Anteil am besten mittels SD-OCT abgegrenzt werden. Die RPE-Atrophie war bestmöglich mittels FAF darstellbar, jedoch war eine Abgrenzung auch mithilfe MC sowie ICGA möglich. Die EZ-Unterbrechung konnte im SD-OCT-b-Scan abgegrenzt werden.

Schlussfolgerung

Die MC ist zur Darstellung von RPE-Atrophie und fibrösem Anteil der fibrosierten CNV, die FAF zur Abgrenzbarkeit der RPE-Atrophie geeignet. Mittels SD-OCT kann der fibröse Anteil der CNV quantifiziert werden; die EZ-Unterbrechung ist im b Scan, jedoch nicht im transverse-structure-Scan abgrenzbar. Mithilfe der OCTA ist eine Detektion des vaskulären Anteils möglich.

Abstract

Background

Under long-term anti-VEGF therapy neovascular age-related macular degeneration (nAMD) may result in fibrovascular transformation of choroidal neovascularization (CNV). So far there is a lack of definitions on how a differentiated quantification of the associated morphological changes can best be carried out. This pilot study aimed to define the most appropriate imaging modalities.

Patients and methods

In 56 eyes with fibrotic CNV after at least 2 years of anti-VEGF therapy and at least 12 intravitreal anti-VEGF injections, the following imaging modalities were investigated with respect to the delimitation of vascular and fibrous portions of CNV as well as associated atrophy of retinal pigment epithelium (RPE) and disruption of the ellipsoid zone (EZ): multicolor imaging (MC), fundus autofluorescence (FAF), fluorescein angiography (FA) and indocyanine green angiography (ICGA), spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA).

Results

The vascular portion of fibrotic CNV was best visualized by OCTA, the fibrous portion by SD-OCT. The RPE atrophy was best delimitated by FAF, but differentiation was also possible by MC and ICGA. Disruption of the EZ could be delineated by SD-OCT b‑scan.

Conclusion

The use of MC is suitable for visualization of RPE atrophy and the fibrous portion of fibrotic CNV and FAF is suitable for differentiation of RPE atrophy. The SD-OCT can be used to quantify the fibrous portion of CNV; the EZ interruption is delimitable in the b‑scan but not in the transverse structure-scan. The vascular part can best be detected by OCTA.

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Förderung

Die Autoren geben an, dass eine Studienfinanzierung durch Novartis Pharma GmbH, Nürnberg, erfolgt ist.

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Authors and Affiliations

  1. Augenzentrum am St. Franziskus-Hospital Münster, Hohenzollernring 74, 48145, Münster, Deutschland

    Marius Book, Martin Ziegler, Kai Rothaus, Henrik Faatz, Marie‑Louise Gunnemann, Georg Spital, Matthias Gutfleisch, Albrecht Lommatzsch & Daniel Pauleikhoff

  2. Klinik für Augenheilkunde, Universitätsklinikum Essen, Essen, Deutschland

    Albrecht Lommatzsch & Daniel Pauleikhoff

  3. Achim-Wessing-Institut für Ophthalmologische Diagnostik, Universitätsklinikum Essen, Essen, Deutschland

    Albrecht Lommatzsch & Daniel Pauleikhoff

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  1. Marius Book
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  2. Martin Ziegler
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  7. Matthias Gutfleisch
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  9. Daniel Pauleikhoff
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Correspondence to Marius Book.

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Interessenkonflikt

M. Book, M. Ziegler, K. Rothaus, H. Faatz, M.-L. Gunnemann, G. Spital, M. Gutfleisch, A. Lommatzsch und D. Pauleikhoff geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Book, M., Ziegler, M., Rothaus, K. et al. Die fibrovaskuläre Umwandlung der CNV bei nAMD unter lang andauernder Anti-VEGF-Therapie. Ophthalmologe 118, 1024–1030 (2021). https://doi.org/10.1007/s00347-020-01261-9

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  • DOI: https://doi.org/10.1007/s00347-020-01261-9

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