Optical Coherence Tomography Angiography cyclic remodeling of CNV in patients affected by BEST Macular Dystrophy

Purpose: To evaluate the effect of photodynamic therapy and/or intravitreal injections on choroidal neovascularization in treatment-naïve patients affected by Best Macular Dystrophy using OCT-A Materials and Methods: BMD patients with CNV treated using PDT and/or IV were included in the study. All patients underwent a complete ophthalmological examination, OCT and 3×3 mm OCT-A. The OCT-A images were analyzed using an open-source software (ImageJ) to assess the CNV membrane area (CNV-MA), the CNV vessel area (CNV-VA) and vessel density (VD) at the follow-ups (3 months after PDT and 1 month after IV). Results: Five eyes of 4 patients with CNV were included. All eyes received PDT as first-line therapy; 4 eyes underwent more than 1 treatment session: 3 eyes received 1 IV, whereas 1 eye had 1 further PDT. After PDT, the CNV-MA, CNV-VA and VD quantitative parameters were obtained for 4 out of 5 eyes: in 3 eyes of 2 patients CNV-MA, CNV-VA and VD first decreased and then gradually increased during follow-up, whereas in 1 eye of 1 patient CNV-MA, CNV-VA and VD slightly increased. After IV the CNV-MA, CNV-VA and VD had significantly decreased at the 1-month follow-up in 3 eyes of 3 patients. Conclusion: OCT-A is an important tool for the diagnosis of both naïve and fibrotic CNV in BMD patients; it is a non-invasive method for the qualitative and quantitative analysis of neovascular lesions during follow-up. Our results have shown a cyclic remodeling of treated CNV in BMD patients using both PDT and IV