Longitudinal Optical Coherence Tomography Angiography Analysis of Nonexudative Macular Neovascularization in...

To investigate the development of macular neovascularization (MNV) and its conversion to the exudative form in fellow eyes of patients with unilateral exudative age-related macular degeneration (AMD) over two years, identify prognostic factors, and assess retinal and choroidal vascular changes using optical coherence tomography angiography (OCTA).

This prospective cohort study initially enrolled 62 patients with exudative AMD in one eye and non-exudative AMD in the fellow eye. Thirty patients completed the two-year follow-up and were categorized into three groups: eyes with nonexudative MNV (neMNV) that developed exudative conversion (Group 1), eyes with stable neMNV without exudative conversion (Group 2), and eyes without detectable MNV (Group 3). Best-corrected visual acuity (BCVA), OCTA parameters, MNV area/flow area and choroidal vascularity index were evaluated at baseline, one-year, and two-years.

Group 1 showed significant declines in mean BCVA and choriocapillaris flow area (p = 0.042 and p = 0.022). Group 2 exhibited a reduction in outer retinal flow area with increased superficial capillary plexus vascular density in parafoveal and temporal regions (p = 0.011, p = 0.008, p = 0.021). Group 3 demonstrated an increase in pigment epithelial detachment (PED) width (p < 0.001). When between and within groups changes over 2 years were analyzed, Group 1 demonstrated greater increases in PED width and central macular thickness, along with reduced choriocapillaris flow area compared with the other groups. Group 2 showed a more pronounced reduction in outer retinal flow area and a significant increase in temporal superficial capillary plexus density relative to the remaining groups.

In patients with unilateral eMNV, OCTA may provide prognostic biomarkers for early detection and monitoring of neMNV in fellow eyes with non-exudative AMD.