Natural History of Treatment-Naïve Quiescent Choroidal Neovascularization in Age-Related Macular Degeneration Using OCT Angiography

Purpose: To describe the evolution of treatment-naïve quiescent choroidal neovascularizations (CNVs) in age-related macular degeneration (AMD) by means of OCT angiography (OCTA).

Design: Prospective, observational, consecutive case series.

Participants: Fifteen eyes (7 right eyes and 8 left eyes) of 14 patients (8 women and 6 men) fulfilled the criteria of quiescent CNV in AMD among an overall pool of 950 neovascular AMD patients.

Methods: Consecutive patients with treatment-naïve quiescent CNV seeking treatment at 2 tertiary referral centers were followed up longitudinally for 1 year after diagnosis. The study included 3 visits at different time points. Each visit included measurement of best-corrected visual acuity, dilated fundus biomicroscopy, structural OCT, and OCTA. At baseline, fluorescein angiography and indocyanine green angiography also were performed to confirm diagnosis. Qualitative and quantitative analysis were assessed during a 12-month follow-up period.

Main Outcome Measures: Qualitative and quantitative assessment of OCTA images and evaluation of the rate of clinical activation.

Results: Fifteen eyes of 14 patients were included in the analysis. Fourteen of 15 CNVs remained quiescent, and the rate of clinical activation was 6.6%. Qualitative analysis disclosed that the CNV core was visible in 2 of 14 eyes at baseline and in 3 of 14 eyes at 6 and 12 months; the CNV margin was well defined in 10 of 14 eyes and the CNV location was foveal involving in 8 of 14 eyes at all time points; CNV growth was displayed in 3 of 14 eyes at 6 months and in 10 of 14 eyes at 12 months compared with baseline images. Quantitative analysis revealed that despite an increase in CNV area (P = 0.039), CNV vessel density did not change (P = 0.731) in quiescent CNVs during follow-up.

Conclusions: We demonstrated biological activity of quiescent CNV by showing lesion growth over 12 months. Biological activity was not paralleled by clinical activity in most cases because of absence of exudation development over time, possibly because of unchanged CNV vessel density despite growth.