VASCULAR REMODELING OF CHOROIDAL NEOVASCULARIZATION AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY VISUALIZED ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY ALEXANDRA MIERE, MD,* PAULINE BUTORI, MD,* SALOMON Y. COHEN, MD, PHD,*† OUDY SEMOUN, MD,* VITTORIO CAPUANO, MD,* CAMILLE JUNG, MD, PHD,† ERIC H. SOUIED, MD, PHD*† Purpose: To describe the qualitative and quantitative changes in choroidal neovascula- rization (CNV) flow pattern after anti–vascular endothelial growth factor therapy, by optical coherence tomography angiography (OCTA). Methods: Consecutive patients with neovascular age-related macular degeneration underwent multimodal imaging, including OCTA at initial examination and at last visit. High- flow networks in the choriocapillaris segmentation of OCTA were qualitatively and quantitatively analyzed at baseline and at follow-up, to characterize vascular flow changes after anti–vascular endothelial growth factor treatment and to correlate these changes with final exudation signs on spectral domain optical coherence tomography. Results: Seventeen eyes were included. Mean follow-up was of 11.7 ± 3.3 months. Baseline images showed six medusa pattern (35.3%), four seafan pattern (23.5%), and seven indistinct network patterns (41.2%). Mean CNV area at baseline was 1.58 ± 1.72 mm 2 . Final OCTA images revealed a decrease in CNV total area of 21.6%. In 6/17 eyes, the baseline neovascular pattern was unchanged; these cases were associated with exudation at the final spectral domain optical coherence tomography examination (P = 0.034) and a decrease in CNV area of 34.1%. Conversely, in 11/17 eyes (64.7%), the initial pattern had changed to a pruned vascular tree pattern, with variable exudative status on spectral domain optical coherence tomography at the final visit and a decrease in total CNV area of 0.07%. Conclusion: The vascular flow remodeling induced by recurrent anti–vascular endo- thelial growth factor treatment can be assessed by OCTA. Optical coherence tomography angiography may help to accurately evaluate treatment response and to recognize patterns usually associated with recurrent exudative activity. RETINA 0:1–10, 2017 E xudative age-related macular degeneration (AMD) is the first cause of vision impairment in western countries. 1,2 Choroidal neovascularization (CNV) plays a key role in the pathogenesis of AMD. Classi- cally, fluorescein angiography is the gold standard for diagnosing CNV. 3,4 Angiographic features of CNV types associated with neovascular AMD have been extensively described, to clearly delineate between occult CNV (Type 1), 3,5 classic CNV (Type 2), 6 and Type 3 neovascularization (retinoretinal or retinochor- oidal anastomosis). 7–9 Staining and leakage on late frames of the fluorescein angiography examination generate essential images for the diagnosis of exuda- tive AMD. However, intravenous fluorescein injection is known to have various side effects, ranging from nausea to anaphylaxis. 10 Thus, the advent of high- resolution optical coherence tomography provided a noninvasive structural imaging technique for patients 1 Copyright ª by Ophthalmic Communications Society, Inc. Unauthorized reproduction of this article is prohibited.