TO EVALUATE THE ROLE OF FUNDUS FLUORESCEIN ANGIOGRAPHY (FFA) AND SPECTRAL DOMAIN-OPTICAL COHERENCE TOMOGRAPHY (SD-OCT) IN CHOROIDAL NEOVASCULARISATION (CNV)

Abstract

Background: Choroidal neovascularisation (CNV) originates from the choroid and is located initially within the layers of Bruch's membrane. CNV may occur as an idiopathic entity or in association with number of pathological conditions like age-related macular degeneration (AMD), ocular hisptoplasmosis, pathologic myopia, angiod streaks, choroidal tears and in certain inflammatory diseases of choroid and retina. It can cause severe visual loss due to leakage, haemorrhage and scar tissue formation damaging the photoreceptors and the RPE. To diagnose CNV special imaging of eye are taken. These images are taken using fluorescein angiography (FA) and optical coherence tomography (OCT). During FA, a fluorescein dye is injected into a vein in the arm.  

Objectives: To evaluate the role of Fundus fluorescein angiography (FFA) and spectral domain-optical coherence tomography (SD-OCT) in choroidal neo-vascularisation (CNV).

Methods: All patients attending the ophthalmology OPD or admitted in the ophthalmology ward clinically diagnosed with Choroidal Neovascularisation (CNV) were enrolled in this study. 3 ml of 20% fluorescein from the original sterile container was used. For pupil dilation, 1% tropicamide and 10% phenylephrine were used. As a general protocol, we originally used a drop of each solution in each eye. If proper pupil dilation is not achieved in 10 minutes, we added another set of drops. A third row of drops was needed especially in the patients with very dark eyes, in patients with glaucoma medication or following cataract surgery. All investigations were made in the presence of a physician specialized in Intensive care, equipped with emergency oxygen source, stethoscope, Sphygmomanometer, intubation kit, intravenous needles, fluids, intravenous medication, epinephrine and an antihistamine.  

Results: The present prospective study was conducted on patients clinically diagnosed with neovascularization (CNV). 87% were in their 5^th to 7^th decade of life with a mean age of 67.8+8.91 years. Male predominance with 59.7% (males) versus 4.3% (females). 62.9% smokers in our study. 93.5% patients presenting with defective vision, defective vision + metamorphosia was seen in 4.8%. 83.9% bilateral eye involvement. 56.1% patients had 6/60-1/60 visual acuity. Hyperpigmentation in macular area was found in all eyes. OCT showed sensitivity of 79.1% and specificity 84.3%. All patients attending the ophthalmology OPD or admitted in the ophthalmology ward clinically diagnosed with Choroidal Neovascularisation (CNV). SD-OCT could not detect CNVM in 3 patients with cataract which was finally detected and visualized using FFA.

Conclusion: It is concluded that SDOCT is highly sensitive for identifying AMD, CNV, and CNV activity and due to its non-invasive nature with no adverse effects and less time consuming can be used as a first line of diagnostic modality and FFA be reserved for cases where SD-OCT is not helpful.