Activity of neovascular lesions treated with bevacizumab: comparison between optical coherence tomography and fluorescein angiography

Purpose To investigate whether examination with the non-invasive optical coherence tomography (OCT) alone is sufficient to ascertain the need of re-treatment with bevacizumab for exudative age-related macular degeneration (AMD) or the invasive fluorescein angiography (FA) is needed. Method Two independent examiners reviewed FA and OCT images and performed a semi-quantitative assessment from 0=no activity to activity 1-3, mild, moderate and advanced, respectively. Weighted Kappa indices were performed to calculate the concordance between OCT and FA. Results A total of 153 OCT and FA examinations of 69 patients were evaluated, mean 2.2 examinations per patient. The mean age was 77.1 +/- 7.9 (55-89) years; 29.0% were male, 71.0% female. The weighted Kappa index showed concordance for activity in OCT and FA weak concerning the first investigation 4-6 weeks after initial treatment (0.3847) and obvious concerning the second investigation 8-10 weeks after initial treatment (0.4170). Higher values of activity were found with the OCT compared to FA. The most frequent reasons for discrepancies were detachment of the pigmentepithelium and fibrosis. Conclusion There is evidence of agreement between both examinations, the OCT was even more sensitive to detect activity of a lesion. In conducting studies based on OCT as single examination, it should be clearly defined how long fibrotic lesions or lesions with pigment epithelial detachment should be re-treated.