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Evaluation of chorioretinal complex structure changes in patients with anti-VEGF resistant choroidal neovascularization

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Purpose: to evaluate chorioretinal complex changes in patients with chorioretinal neovascularization and lack of anti-VEGF therapy effect, based on modern diagnostic methods in order to determine preferable treatment strategy. Methods: twenty one eyes of nineteen patients with diagnosis “choroidal neovascularisation” and lack of at least three intravitreal Ranibizumab injections effect were included in the study. They underwent comprehensive ophthalmic examination included best-corrected visual acuity (BCVA), microperimetry, central foveal thickness measurement by optical coherence tomography, autofluorescence, fluorescein angiography, indocyanine green angiography. The choroidal thickness was measured by enhanced depth imaging spectral-domain optical coherence tomography through the foveal center from the outer border of the retinal pigment epithelium to the inner scleral border. Results: according to the results of examination 4 patterns of chorioretinal complex pathologic changes were found: 1 – type 1 choroidal neovascularization; 2 – polypoidal choroidal vasculopathy; 3 – type 1 choroidal neovascularization and polyps combination; 4 – chronic central serous chorioretinopathy. Different pathogenetic base of detected patterns of chorioretinal changes may explain less effectiveness of anti-VEGF therapy. Conclusion: сomprehensive ophthalmic examination including evaluation of anatomic and functional chorioretinal changes enables to clarify the diagnosis and to determine preferable treatment strategy of patients with presumed choroidal neovascularization.

Keywords

choroidal neovascularisation; polypoidal choroidal vasculopathy; chronic central serous chorio-retinopathy; anti-VEGF; choroidal thickness

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DOI

10.20310/1810-0198-2016-21-4-1517-1524

UDC

617.736

Pages

1517-1524

References

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Received

2016-03-18

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Scholarly articles

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