Optical coherence tomography angiography (OCTA) analysis of cohort with peripapillary choroidal neovascularization.

Purpose: While many studies have analyzed macular choroidal neovascularization (CNV) using OCTA, few have focused on peripapillary CNV, which comprises approximately 10% of CNV cases. This study examines OCTA vessel changes in treated and untreated peripapillary CNV patients to better understand disease progression.

Methods: Nineteen eyes with peripapillary CNV secondary to neovascular age-related macular degeneration (nAMD) were retrospectively analyzed. Treated eyes (n=13) received anti-VEGF injections following a modified pro re nata (PRN) regimen, while untreated eyes (n=6) without macular involvement were closely observed. Median follow-up was 11.9 months (treated) and 8 months (untreated). High-quality OCTA scans centered on the CNV lesions were selected and analyzed using validated software (ImageJ and AngioTool).

Results: Treated eyes showed significant reductions in CNV lesion size, vessel density, and lacunarity after anti-VEGF therapy (ImageJ: p<0.001; AngioTool: p=0.0004). Untreated eyes exhibited significant lesion enlargement (ImageJ: p=0.0356; AngioTool: p=0.0013). None of the patients in the untreated group developed macular exudation during the study.

Conclusion: Peripapillary CNV without macular involvement may be considered for short-term observation in selected cases, as these lesions appeared indolent and stable over the limited follow-up period in our cohort. The vessels in OCTA in the treated group showed regression in size after anti-VEGF therapy. These findings will potentially help clinicians better understand this entity.