ABSTRACT
PURPOSE: To describe four cases of varix of the vortex vein ampulla imaged with dynamic echography. METHODS: Observational case series of four patients with varix of the vortex vein ampulla diagnosed with ocular examination maneuvers such as digital pressure or Valsalva. Dynamic echography was used to confirm the diagnosis. RESULTS: Dynamic echography can quickly and noninvasively show the varix of the vortex vein ampulla disappear with external pressure, or engorge with a Valsalva maneuver or altered gaze directions. CONCLUSION: Dynamic echography is very helpful in the establishment of the diagnosis of varix of the vortex vein ampulla and differentiating this benign condition from other retinal or choroidal abnormalities.
Subject(s)
Choroid , Varicose Veins , Choroid/blood supply , Diagnosis, Differential , Humans , Ultrasonography , Varicose Veins/diagnostic imagingABSTRACT
OBJECTIVES: To determine if commercial OCTA measurements can provide quantitative biomarkers for detection of radiation retinopathy (RR) s/p I-125 plaque brachytherapy in patients with uveal melanoma. METHODS: Retrospective review of 6 × 6 mm OCTA images of nonirradiated fellow eyes (group 1, 28 eyes), eyes without RR (group 2, 22 eyes), eyes with RR (group 3, 13 eyes). We used automated AngioVue AngioAnalytics OCTA software determinations of FAZ size, perimeter size, and 27 capillary density measurements (nine regions of each segmentation: full-thickness retina, superficial plexus, deep plexus). RESULTS: Average time since irradiation was 1.9 years in group 2, and 3.7 years in group 3. FAZ size was 1.2 mm in group 3 compared with 0.2 mm in group 1 and 0.3 mm in group 2 (both p < 0.001). Capillary density was statistically significantly reduced in group 3 compared with group 1 in all 27 regions. Group 2 had significantly decreased superficial plexus capillary density compared with group 1 in three regions. Group 3 had significantly reduced capillary density compared with group 2 in 6/27 (22%) regions. Linear regression showed a change in whole-scan density of -1.5 per year after irradiation in the full-thickness retina segmentation (p = 0.008). CONCLUSION: Quantitative OCTA may aid in early detection of RR.
Subject(s)
Macula Lutea , Retinal Diseases , Fluorescein Angiography , Fundus Oculi , Humans , Iodine Radioisotopes , Melanoma , Retinal Vessels , Retrospective Studies , Tomography, Optical Coherence , Uveal Neoplasms , Visual AcuityABSTRACT
BACKGROUND: To demonstrate a technique for using optical coherence tomography angiography (OCTA) to simulate leakage in eyes with diabetic macular oedema and determine the sensitivity and positive predictive value of detecting leaking microvasculature on OCTA using fluorescein angiography (FA) as the comparative norm. METHODS: 6×6 mm OCT angiograms were overlaid with the corresponding OCT thickness maps. Microvascular abnormalities on the OCT angiogram underlying areas of thickening on the OCT thickness map were assumed to be leaking. Two independent readers blindly read the OCTA overlay images then the FA images cropped to the same approximate region to delineate areas of leaking microvasculature. The results were compared to determine the sensitivity and positive predictive value of OCTA for detection of leaking vessels. RESULTS: 28 eyes of 19 diabetic patients were included. Each eye demonstrated an average of seven leaking microvascular abnormalities on the OCTA images and 22 leaking abnormalities on the FA images. Sensitivity of leaking microvasculature detection by OCTA was 26.1% and positive predictive value was 68.4%. The correlation coefficient of the two readers' detection of leaking microvasculature was 0.605 for OCTA reads compared with 0.916 for FA. CONCLUSION: OCTA as a whole can be used to simulate leakage, but currently, sensitivity of the technique is low. Further understanding of the OCTA technology may yield novel means of detecting retinal pathology.
Subject(s)
Capillary Permeability , Diabetic Retinopathy/diagnosis , Macular Edema/diagnosis , Retinal Vessels/pathology , Adult , Aged , Aged, 80 and over , Diabetic Retinopathy/physiopathology , False Positive Reactions , Female , Fluorescein Angiography , Humans , Macular Edema/physiopathology , Male , Middle Aged , Predictive Value of Tests , Retinal Vessels/diagnostic imaging , Sensitivity and Specificity , Tomography, Optical Coherence , Visual AcuitySubject(s)
Cerebrovascular Disorders/complications , Cranial Sinuses/pathology , Papilledema/etiology , Adult , Humans , MaleABSTRACT
PURPOSE: Determine sensitivity and specificity of polypoidal choroidal vasculopathy (PCV) diagnosis with structural en face optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS: Retrospective review of the medical records of eyes diagnosed with PCV by indocyanine green angiography with review of diagnostic testing with structural en face OCT and OCTA by a trained reader. Structural en face OCT, cross-sectional OCT angiograms alone, and OCTA in its entirety were reviewed blinded to the findings of indocyanine green angiography and each other to determine if they could demonstrate the PCV complex. Sensitivity and specificity of PCV diagnosis was determined for each imaging technique using indocyanine green angiography as the ground truth. RESULTS: Sensitivity and specificity of structural en face OCT were 30.0% and 85.7%, of OCT angiograms alone were 26.8% and 96.8%, and of the entire OCTA were 43.9% and 87.1%, respectively. Sensitivity and specificity were improved for OCT angiograms and OCTA when looking at images taken within 1 month of PCV diagnosis. CONCLUSION: Sensitivity of detecting PCV was low using structural en face OCT and OCTA but specificity was high. Indocyanine green angiography remains the gold standard for PCV detection.
Subject(s)
Choroid Diseases/diagnosis , Choroid/blood supply , Fluorescein Angiography/methods , Polyps/diagnosis , Tomography, Optical Coherence/methods , Aged , Choroid/diagnostic imaging , Female , Fundus Oculi , Humans , Male , Middle Aged , ROC Curve , Retrospective StudiesABSTRACT
PURPOSE: To compare the diagnostic ability of optical coherence tomography angiography (OCTA) with indocyanine green angiography (ICGA) in polypoidal choroidal vasculopathy (PCV). METHODS: Retrospective review of 47 eyes with PCV imaged with ICGA and OCTA. For each eye, it was determined which imaging modality better delineated the PCV complex. The presence of a branching vascular network (BVN) and polyp(s) were noted. RESULTS: PCV was better visualized with ICGA in 21 eyes (44.7%) and with OCTA in 9 eyes (19.2%). The results were comparable in 17 eyes (36.2%). Of the 44 eyes with BVN on ICGA, 41 eyes (93.2%) also showed BVN on OCTA. Of the 28 eyes with polyp(s) on ICGA, 22 eyes (78.6%) also showed polyp(s) on OCTA. Polyps were high-flow lesions or faint low-flow dilations on OCTA. CONCLUSION: OCTA readily detects BVNs and can detect most polyps, but in many cases ICGA is better able to detect the PCV complex.
Subject(s)
Choroid/blood supply , Choroidal Neovascularization/diagnosis , Fluorescein Angiography/methods , Polyps/diagnosis , Tomography, Optical Coherence/methods , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reproducibility of Results , Retrospective StudiesABSTRACT
OBJECTIVE: To describe optical coherence tomography angiography (OCTA) reflectance artifacts secondary to retinal pigment epithelial detachment (RPED). DESIGN: Retrospective review. METHODS: Four eyes from 4 subjects were included. Three presented with RPED and 1 eye was a normal control. Two eyes diagnosed with RPED and the normal eye were evaluated using en face OCTA centred at the fovea acquired using the RTVue XR Avanti (Optovue Inc). In the third eye with RPED, OCTA imaging was performed using a CIRRUS 5000 prototype modified to do OCTA imaging on a spectral domain OCT platform provided by Carl Zeiss Meditec, Inc. The segmented OCTA angiograms were overlaid to determine if the flow patterns seen at the edge of the RPEDs were due to reflectance from the inner retinal vessels, also known as "decorrelation tails." RESULTS: OCTA projection artifacts were noted when segmentation lines intersected with the boundary of the RPED. The overlaid segmented OCTA from the 3 RPED eyes imaged using each system revealed the same vasculature pattern at the edges of the RPED as that of the inner retina, demonstrating the "decorrelation tails" artifact, which caused the RPED to appear as a bright ring on the segmented OCTA. CONCLUSIONS: OCTA images are susceptible to various known artifacts. This series describes the impact of the projection artifact seen at the edges of an RPED that simulates appearance of flow but is actually due to reflectance of the inner retinal vasculature on the RPED.
Subject(s)
Artifacts , Fluorescein Angiography/methods , Retinal Detachment/diagnosis , Retinal Pigment Epithelium/pathology , Retinal Vessels/pathology , Tomography, Optical Coherence/methods , Female , Fundus Oculi , Humans , Male , Retrospective StudiesABSTRACT
PURPOSE: To evaluate the characteristics and racial variations amongst patients with polypoidal choroidal vasculopathy (PCV) in the United States and the United Kingdom. METHODS: Fundus photos and indocyanine green angiography images were evaluated in a multicenter retrospective study to establish the diagnosis of PCV. Visual acuity (VA) was recorded in ETDRS letter count. RESULTS: Eighty eyes of 71 PCV patients (average age of 69.4 ± 10.4 years) were included in the analysis. Of the total 71 subjects, 46 (65%) were women, 33 (46.5%) were Blacks, 16 (22.5%) were Whites, 19 (26.8%) were Asians and 3 (4.2%) belonged to other races. The Black subgroup had vision gain of 3.5 letters. The White and Asian subgroups had vision loss of 13.1 and 3.5 letters, respectively. There was female predominance in Blacks (67%), Whites (69%), and Asians (58%). PCV was found to be a bilateral disease in 14 patients (20%). There was significant decrease of 7 letters with every decade increase in age (p = 0.005). Final VA was worse in males when compared to females (p = 0.042), and worse in Whites when compared to Blacks (p = 0.005). For every 10 letters worse in initial VA upon diagnosis with PCV, the final VA was worse by 6 letters (p < 0.001). The location of the polypoidal lesion within the macula was associated with significant decrease of 14 letters in BCVA (p = 0.02). The length of follow up was significantly associated with worse visual outcome (p = 0.012). Final VA had no significant correlation with the lens status, or the different treatment modalities. CONCLUSIONS: Based on our cohort from tertiary centers in the United States and United Kingdom, PCV is a bilateral disease in one-fifth of patients. It features a variable female predominance based on ethnicity. Increased age, worse vision upon initial presentation, longer follow up and macular location of the polyp were associated with worse visual outcome.
ABSTRACT
IMPORTANCE: Alterations in ocular blood flow play an important role in the pathogenesis and progression of diabetic retinopathy (DR). However, the measurement of retinal blood flow in clinical studies has been challenging. En face Doppler optical coherence tomography (OCT) provides an effective method for measuring total retinal blood flow (TRBF) in the clinic. OBJECTIVE: To investigate TRBF in eyes with DR of varying severity, with or without diabetic macular edema (DME), using en face Doppler OCT. DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional study conducted from May 23, 2014, to January 11, 2016, which analyzed 41 eyes with DR from 31 diabetic patients, 20 eyes without DR from 11 diabetic patients, and 16 eyes from 12 healthy age-matched controls, all at the New England Eye Center in Boston, Massachusetts. MAIN OUTCOMES AND MEASURES: Participants were imaged with a high-speed, swept-source OCT prototype at 1050-nm wavelength using repeated en face Doppler OCT raster scans, comprising 600 × 80 axial scans and covering a 1.5 × 2-mm2 area centered at the optic disc. The TRBF was automatically calculated using custom Matlab software. RESULTS: This study included 41 eyes with DR from 31 diabetic patients (mean [SD] age, 62.8 [13.4] years; 12 were female patients), 20 eyes without DR from 11 diabetic patients (mean [SD] age, 58.8 [10.1] years; 5 were female patients), and 16 eyes from 12 healthy age-matched controls (mean [SD] age, 57.9 [8.1] years; 8 were female participants). The mean (SD) TRBF was 28.0 (8.5) µL/min in the eyes with DME, 48.8 (13.4) µL/min in the eyes with DR but without DME, 40.1 (7.7) µL/min in the diabetic eyes without retinopathy, and 44.4 (8.3) µL/min in age-matched healthy eyes. A difference in TRBF between the eyes with DME that were treated and the eyes with DME that were not treated was not identified. The TRBF was consistently low in the eyes with DME regardless of DR severity. The eyes with moderate nonproliferative DR but without DME exhibited a wide range of TRBF from 31.1 to 75.0 µL/min, with the distribution being highly skewed. CONCLUSIONS AND RELEVANCE: High-speed en face Doppler OCT can measure TRBF in healthy and diabetic eyes. Diabetic eyes with DME exhibited lower TRBF than healthy eyes (P ≤ .001). Further longitudinal studies of TRBF in eyes with DR would be helpful to determine whether reduced TRBF is a risk factor for DME.
Subject(s)
Diabetic Retinopathy/diagnosis , Macular Edema/diagnosis , Regional Blood Flow/physiology , Retina/physiopathology , Retinal Vessels/physiopathology , Tomography, Optical Coherence/methods , Cross-Sectional Studies , Diabetic Retinopathy/complications , Diabetic Retinopathy/physiopathology , Doppler Effect , Female , Follow-Up Studies , Humans , Image Processing, Computer-Assisted/methods , Macular Edema/etiology , Macular Edema/physiopathology , Male , Middle Aged , Retina/pathology , Retinal Vessels/diagnostic imaging , Retrospective Studies , Severity of Illness IndexABSTRACT
PURPOSE: To determine the sensitivity of the combination of optical coherence tomography angiography (OCTA) and structural optical coherence tomography (OCT) for detecting type 1 neovascularization (NV) and to determine significant factors that preclude visualization of type 1 NV using OCTA. METHODS: Multicenter, retrospective cohort study of 115 eyes from 100 patients with type 1 NV. A retrospective review of fluorescein (FA), OCT, and OCTA imaging was performed on a consecutive series of eyes with type 1 NV from five institutions. Unmasked graders utilized FA and structural OCT data to determine the diagnosis of type 1 NV. Masked graders evaluated FA data alone, en face OCTA data alone and combined en face OCTA and structural OCT data to determine the presence of type 1 NV. Sensitivity analyses were performed using combined FA and OCT data as the reference standard. RESULTS: A total of 105 eyes were diagnosed with type 1 NV using the reference. Of these, 90 (85.7%) could be detected using en face OCTA and structural OCT. The sensitivities of FA data alone and en face OCTA data alone for visualizing type 1 NV were the same (66.7%). Significant factors that precluded visualization of NV using en face OCTA included the height of pigment epithelial detachment, low signal strength, and treatment-naïve disease (P < 0.05, respectively). CONCLUSIONS: En face OCTA and structural OCT showed better detection of type 1 NV than either FA alone or en face OCTA alone. Combining en face OCTA and structural OCT information may therefore be a useful way to noninvasively diagnose and monitor the treatment of type 1 NV.
Subject(s)
Choroid/pathology , Choroidal Neovascularization/diagnosis , Fluorescein Angiography/methods , Retinal Vessels/pathology , Tomography, Optical Coherence/methods , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fundus Oculi , Humans , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Severity of Illness Index , Time Factors , Visual AcuityABSTRACT
BACKGROUND AND OBJECTIVE: To describe optical coherence tomography angiography (OCTA) findings in patients with unilateral Coats' disease. PATIENTS AND METHODS: Retrospective, observational case series of four patients with unilateral Coats' disease who underwent bilateral OCTA imaging. RESULTS: Bilateral macular OCTA findings of eight eyes are described. An abnormal foveal avascular zone (FAZ) with inner retinal vessels traversing the avascular zone in the superficial capillary plexus was visible on OCTA in the affected eye of all four patients. A similarly abnormal FAZ was noted on OCTA in the clinically normal fellow eye in two of the four patients (50%). CONCLUSION: OCTA may demonstrate an abnormal foveal avascular zone in both the affected eye and the clinically unaffected fellow eye, suggesting widespread pathology of the retinal vasculature in Coats' disease. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:632-635.].
Subject(s)
Fluorescein Angiography/methods , Retinal Telangiectasis/diagnosis , Retinal Vessels/pathology , Tomography, Optical Coherence/methods , Adolescent , Adult , Female , Fundus Oculi , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
PURPOSE: To evaluate the perifoveolar retinal capillary network at different depths and to quantify the foveal avascular zone (FAZ) in eyes with retinal vein occlusion (RVO) compared with their fellow eyes and healthy controls using spectral-domain optical coherence tomography angiography (SD-OCTA). METHODS: We prospectively recruited 23 patients with RVO including 15 eyes with central RVO (CRVO) and 8 eyes with branch RVO (BRVO), their fellow eyes, and 8 age-matched healthy controls (8 eyes) for imaging on prototype OCTA software within RTVue-XR Avanti. The 3 × 3 mm and 6 × 6 mm en face angiograms of superficial and deep retinal capillary plexuses were segmented. Perifoveolar retinal capillary network was analyzed and FAZ was quantified. RESULTS: Decrease in vascular perfusion at the deep plexus was observed in all eyes with CRVO (8/8, 100%) and BRVO (6/6, 100%) without cystoid macular edema, and in 8 of 15 (53%) and 2 of 8 (25%) of the fellow eyes, respectively. Vascular tortuosity was observed in 13 of 15 (87%) CRVO and 5 of 8 (63%) BRVO eyes. Collaterals were seen in 10 of 15 (67%) CRVO and 5 of 8 (63%) BRVO eyes. Mean FAZ area was larger in eyes with RVO than their fellow eyes (1.13 ± 0.25 mm2 versus 0.58 ± 0.28 mm2; P = 0.007) and controls (1.13 ± 0.25 mm2 versus 0.30 ± 0.09 mm2; P < 0.0001), and in fellow eyes of RVO patients when compared to controls (0.58 ± 0.28 mm2 versus 0.30 ± 0.09 mm2; P = 0.01). CONCLUSIONS: Spectral-domain OCTA reveals abnormalities at different levels of perifoveolar retinal capillary network and is able to quantify the FAZ in RVO. Longitudinal studies may be considered to evaluate the clinical utility of OCTA in RVO and other retinal vascular diseases.
Subject(s)
Fluorescein Angiography/methods , Fovea Centralis/pathology , Microcirculation/physiology , Regional Blood Flow/physiology , Retinal Vein Occlusion/diagnosis , Retinal Vessels/physiopathology , Tomography, Optical Coherence/methods , Aged , Capillaries/pathology , Female , Follow-Up Studies , Fundus Oculi , Humans , Male , Middle Aged , Prospective Studies , Retinal Vein Occlusion/physiopathology , Retinal Vessels/pathology , Visual AcuityABSTRACT
PURPOSE: To characterize the features of choroidal neovascularization (CNV) in neovascular age-related macular degeneration with spectral domain optical coherence tomography angiography (OCTA) and to determine whether OCTA can be used to determine clinical activity of CNV. METHODS: Observational, retrospective, consecutive case series. RESULTS: Optical coherence tomography angiography revealed CNV in 28 eyes (62.2%) while 17 eyes (37.8%) did not demonstrate CNV vessels. Choroidal neovascularization was classified as well circumscribed in 12 eyes (42.8%) and poorly circumscribed in 16 eyes (57.2%). Twenty-two eyes with a CNV on OCTA were clinically active, whereas six eyes with visible CNV on OCTA were clinically inactive. Of the 17 eyes that did not have evidence of CNV on OCTA imaging, 14 were clinically inactive and 3 were clinically active. Presence of CNV on OCTA correlated with clinical activity and absence of CNV correlated with inactivity (P < 0.0001). CONCLUSION: Optical coherence tomography angiography is a noninvasive imaging technique that can be used to visualize blood flow comprising CNV. Optical coherence tomography angiography detects CNV vessels in some albeit not all eyes with neovascular age-related macular degeneration. Although the presence or absence of CNV vessels on OCTA highly correlated with clinical activity of CNV, the morphologic appearance of CNV on OCTA did not have significant correlation with clinical activity.
Subject(s)
Choroidal Neovascularization/diagnostic imaging , Fluorescein Angiography , Tomography, Optical Coherence/methods , Wet Macular Degeneration/pathology , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Wet Macular Degeneration/diagnostic imagingABSTRACT
IMPORTANCE: Optical coherence tomographic angiography (OCTA) is a recently developed noninvasive imaging technique that can visualize the retinal and choroidal microvasculature without the injection of exogenous dyes. OBJECTIVE: To evaluate the potential clinical utility of OCTA using a prototype swept-source OCT (SS-OCT) device and compare it with fluorescein angiography (FA) for analysis of the retinal microvasculature in diabetic retinopathy. DESIGN, SETTING, AND PARTICIPANTS: Prospective, observational cross-sectional study conducted at a tertiary care academic retina practice from November 2013 through November 2014. A cohort of diabetic and normal control eyes were imaged with a prototype SS-OCT system. The stage of diabetic retinopathy was determined by clinical examination. Imaging was performed using angiographic 3 × 3-mm and 6 × 6-mm SS-OCT scans to generate 3-dimensional en-face OCT angiograms for each eye. Two trained Boston Image Reading Center readers reviewed and graded FA and OCTA images independently. MAIN OUTCOMES AND MEASURES: The size of the foveal nonflow zone and the perifoveal intercapillary area on OCTA were measured in both normal and diabetic eyes using Boston Image Reading Center image analysis software. RESULTS: The study included 30 patients with diabetes (mean [SD] age, 55.7 [10] years) and 6 control individuals (mean [SD] age, 55.1 [6.4] years). A total of 43 diabetic and 11 normal control eyes were evaluated with OCTA. Fluorescein angiography was performed in 17 of 43 diabetic eyes within 8 weeks of the OCTA. Optical coherence tomographic angiography was able to identify a mean (SD) of 6.4 (4.0) microaneurysms (95% CI, 4.4-8.5), while FA identified a mean (SD) of 10 (6.9) microaneurysms (95% CI, 6.4-13.5). The exact intraretinal depth of microaneurysms on OCTA was localized in all cases (100%). The sensitivity of OCTA in detecting microaneuryms when compared with FA was 85% (95% CI, 53-97), while the specificity was 75% (95% CI, 21-98). The positive predictive value and the negative predictive value were 91% (95% CI, 59-99) and 60% (95% CI, 17-92), respectively. CONCLUSIONS AND RELEVANCE: Optical coherence tomographic angiography enables noninvasive visualization of macular microvascular pathology in eyes with diabetic retinopathy. It identified fewer microaneurysms than FA, but located their exact intraretinal depth. Optical coherence tomographic angiography also allowed the precise and reproducible delineation of the foveal nonflow zone and perifoveal intercapillary area. Evaluation of OCTA may be of clinical utility in the evaluation and grading of diabetic eye disease.
Subject(s)
Diabetic Retinopathy/diagnosis , Fluorescein Angiography , Retinal Vessels/pathology , Tomography, Optical Coherence , Adult , Aged , Cross-Sectional Studies , False Positive Reactions , Female , Healthy Volunteers , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
BACKGROUND AND OBJECTIVE: To describe the appearance of diabetic macular edema (DME) using optical coherence tomography angiography (OCTA) and distinguish it from capillary nonperfusion. PATIENTS AND METHODS: Patients with DME were recruited for OCTA imaging. Eyes with confounding retinal diseases were excluded. Using 3 mm × 3 mm OCT angiograms segmented into the superficial and deep inner retinal vascular plexuses, two graders described the appearance of DME and confirmed the diagnosis with structural OCT and fluorescein angiography. RESULTS: DME was evaluated in 17 eyes of 12 patients. The cystoid spaces in DME appeared completely devoid of flow on the OCT angiograms and were oblong in shape with smooth borders that did not follow the distribution of surrounding capillaries, whereas areas of capillary nonperfusion were a greyer hue and had irregular borders. CONCLUSIONS: The cystoid spaces in DME can be differentiated from capillary nonperfusion using OCTA. OCTA may help to guide treatment decisions in the future.
Subject(s)
Diabetic Retinopathy/diagnosis , Macular Edema/diagnosis , Retinal Neovascularization/diagnosis , Retinal Vessels/pathology , Aged , Angiogenesis Inhibitors/therapeutic use , Capillaries , Diabetic Retinopathy/drug therapy , Diabetic Retinopathy/physiopathology , Female , Fluorescein Angiography , Humans , Macular Edema/drug therapy , Macular Edema/physiopathology , Male , Middle Aged , Retinal Neovascularization/drug therapy , Retinal Neovascularization/physiopathology , Retrospective Studies , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitorsABSTRACT
BACKGROUND AND OBJECTIVE: To describe a method for visualizing preretinal neovascularization in proliferative diabetic retinopathy (PDR) using optical coherence tomography angiography (OCTA) and report the findings in the surrounding vasculature. PATIENTS AND METHODS: Patients with PDR diagnosed on clinical examination who received OCTA scans using the RTVue XR Avanti (Optovue, Fremont, CA) were evaluated. To visualize preretinal neovascularization, OCT angiograms were segmented to project vasculature above the internal limiting membrane (ILM). OCT angiograms were segmented between the ILM and Bruch's membrane to show adjacent retinal vasculature. RESULTS: Thirteen eyes were determined to have preretinal neovascularization in the posterior pole based on OCTA. One OCT angiogram was not of sufficient quality and thus was eliminated from further study. Eleven eyes (92%) had neovascularization adjacent to retinal capillary nonperfusion and six (50%) were adjacent to intraretinal microvascular abnormalities (IRMAs). CONCLUSION: OCTA provided high-resolution, depth-resolved blood flow information, allowing for visualization of preretinal neovascularization, IRMA, and adjacent capillary nonperfusion.
Subject(s)
Diabetic Retinopathy/diagnosis , Retinal Neovascularization/diagnosis , Adult , Aged , Diabetic Retinopathy/physiopathology , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Regional Blood Flow , Retinal Neovascularization/physiopathology , Retinal Vessels/pathology , Retrospective Studies , Tomography, Optical CoherenceABSTRACT
BACKGROUND AND OBJECTIVE: To describe the retinal vasculature and choriocapillaris, as well as the transition zone between the diseased and healthy tissue, in eyes with inherited retinal degenerations using optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: Patients with inherited retinal degenerations were recruited for OCTA imaging. Retinal vasculature was assessed for increased intercapillary space and foveal avascular zone abnormalities. Choriocapillaris, retinal pigment epithelium (RPE), and photoreceptor disruption were noted, and the borders were evaluated to speculate which layers become affected first. RESULTS: Fourteen eyes of seven subjects with inherited retinal degenerations were included. All eyes (100%) demonstrated retinal thinning and increased intercapillary spaces overlying focal outer retinal changes. In all eyes, the region of choriocapillaris changes was smaller than the region of overlying RPE and photoreceptor alteration, suggesting the vascular loss was secondary. CONCLUSION: OCTA is able to provide highly detailed vascular information in eyes with inherited retinal degenerations and may be useful to better understand the pathogenesis of these diseases.
Subject(s)
Choroid/blood supply , Eye Diseases, Hereditary/diagnosis , Retinal Degeneration/diagnosis , Retinal Vessels/pathology , Adult , Aged , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Photoreceptor Cells, Vertebrate/pathology , Prospective Studies , Retinal Pigment Epithelium/pathology , Tomography, Optical CoherenceABSTRACT
BACKGROUND AND OBJECTIVE: To assess eyes with flat, irregular retinal pigment epithelial detachments (RPEDs) associated with central serous chorioretinopathy (CSCR) for choroidal neovascularization (CNV) using optical coherence tomography angiography (OCTA). MATERIALS AND METHODS: Retrospective review of OCTA images of chronic CSCR eyes with irregular RPED (group 1) and regular RPED (controls, group 2) for presence of CNV, subretinal fluid, and intraretinal fluid. Fluorescein angiography was also evaluated for CNV. RESULTS: CNV was detected using OCTA in 13 of 31 eyes (41.9%) in group 1 and in one of 18 eyes (5.6%) in group 2 (P = .007). Irregular RPED was a risk factor for CNV (odds ratio [OR] = 12.28; 95% CI, 1.45-104.3). There was no significant difference between detection by OCTA and FA (P = 1.0). Sensitivity and specificity of detection by OCTA were 85.7% and 95.7%, respectively. CONCLUSIONS: Irregular RPEDs in chronic CSCR eyes may harbor neovascularization more often than previously thought, which has implications on therapy.