This paper reports on the optical coherence tomography angiography (OCTA) features of choroidal neovascularisation (CNV) secondary to angioid streaks and the ability to predict CNV activity. A total of 38 eyes of 19 patients were included in the study. Thirty of 38 eyes (17 patients) presented with type 2 CNV; in eight of 38 eyes without CNV (six patients), the qualitative features of angioid streaks were investigated. Based on fundus fluorescein angiography (FFA) findings 5/30 were active CNVs, with 25/30 inactive. For OCTA analysis 10/30 eyes were excluded due to presence of large subretinal fibrotic areas limiting the ability of OCTA to visualise the CNV. On OCTA the CNV shape was circular in 7/20, irregular in 13/20; CNV core was visible in 6/20, not visible in 14/20; CNV margin was well defined in 9/20 and poorly defined in 11/20. The CNV location was foveal sparing in four of 20 eyes and foveal involving in 16 of 20 eyes. A tangled vascular network was found in 13/20 and an interlacing pattern in 7/20. The interlacing appearance was more often associated with signs of neovascular activity on multimodal imaging. The tangled appearance was always associated with the absence of neovascular activity on multimodal imaging. There was a significant association between the described OCTA features and CNV activity (P=0.0014). OCTA features in eyes with angioid streaks but without CNV were hyper reflective lines over background reflectivity on MultiColor and IR imaging, contiguous to hypo reflective lines over background reflectivity. The authors concluded that OCTA is a useful tool not only identifying the presence of CNV but also evaluating its activity in angioid streaks. 

Optical coherence tomography angiography features of angioid streaks.
Corbelli E, Carnevali A, Marchese A, et al.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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