Correlation Between Fluorescein Angiography And Spectral Domain Optical Coherence Tomography For Monitoring Anti-vegf Therapy In Choroidal Neovascularization Secondary To Pathologic Myopia

Purpose To evaluate the agreement between fluorescein angiography (FA) and spectral domain optical coherence tomography (SD-OCT) in detecting the activity of myopic choroidal neovascularization (CNV) during the treatment with intravitreal bevacizumab injection (IVBI). Methods Patients affected by myopic subfoveal CNV were prospectively enrolled in the study; at baseline and at all planned monthly visit, each patient underwent a complete ophthalmological examination, including BCVA assessment on ETDRS charts, slit lamp examination, FA and SD-OCT examination. After the first IVBI (1.25mg), additional injections were performed on the basis of the detection of any type of fluid on SD-OCT and/or presence of leakage or progression on FA. Inter-rater agreement kappa analysis was performed to examine the concordance between FA and SD-OCT in assessing CNV activity. Moreover, considering FA as standard reference examination, sensitivity and specificity were calculated. Results Thirty-four eyes were included in the study. At the baseline, FA and SD-OCT achieved an agreement in 26/34 cases (X%) with a k value of 0.23; sensitivity and specificity were respectively 77.4 and 66.7. The remaining eight cases, 7 eyes presented leakage on FA and absence of fluid on SD-OCT examination, whereas 1 case showed intraretinal fluid on SD-OCT and absence of leakage on FA. At 1-month examination, specificity and K value improved and a concordance was reached in 30/34 cases. At 3- and 4-month examination a discordance was noted in 6 case and the k values were 0.60 and 0.51, respectively. From 5-month examination on, a consensus was achieved in at least 30/34 cases (88%) and reached a complete agreement in 9 sessions. Conclusions The present study reveals that FA still plays a main role in the diagnosis of CNV in myopic eyes. However, it seems possible to hypothesize a role of SD-OCT for monitoring the anti-VEGF treatment over the follow-up.