Evaluation of Type 3 Neovascularization Following Anti-Vascular Endothelial Growth Factor Therapy Using Optical Coherence Tomography Angiography

Objective: To analyze optical coherence tomography angiography (OCTA) imaging of type 3 neovascularization in age-related macular degeneration (AMD) at baseline and following serial anti-vascular endothelial growth factor (anti-VEGF) treatments. Methods: This retrospective case series describes three treatment-naive patients diagnosed with type 3 neovascularization secondary to AMD based on clinical examination, fluorescein angiography (FA), and spectraldomain optical coherence tomography (SD-OCT). Written informed consent was obtained from all participants and approved by the Institutional Review Board of Northwestern University. Visual acuity and OCTA imaging with quantitative analysis of the type 3 neovascular complex was obtained at baseline and following monthly intravitreal anti-VEGF injections. Results: OCTA demonstrated resolution of cystoid macular edema in all three cases following anti-VEGF treatment. In one patient, resolution of the edema allowed enhanced visualization of the type 3 neovascular lesion due to intraretinal fluid obscuration at baseline. One case demonstrated persistence of larger vessels even after multiple anti-VEGF treatments. All cases showed improvement in visual acuity and reduction of type 3 neovascularization area on quantitative OCTA analysis. Conclusion: OCTA analysis of type 3 neovascularization demonstrated regression of small caliber vessels following longitudinal anti-VEGF treatment. Cystoid macular edema resolved and visual acuity improved in all cases. OCTA supplements fluorescein angiography and spectral domain OCT by providing improved microvascular identification of type 3 lesions and treatment response which may help guide clinician management and patient expectations.