Critical guiding role of OCT angiography in long-term treatment and follow-up of neovascular AMD / 中华实验眼科杂志

The pathogenesis of neovascular age-related macular degeneration (nAMD) is complex and macular neovascularization (MNV), a key pathogenic factor in nAMD, is prone to recurrence.Vitreous injection of anti-VEGF drugs is the main therapy of nAMD.In recent years, a lot of progress has been made in fundus imaging techniques and optical coherence tomography angiography (OCTA) with non-invasive, rapid, stratified and high-definition functions has shown strong advantages in diagnosis, differential diagnosis, disease dynamic monitoring and follow-up of nAMD.Clinicians have had a certain understanding of the important role of OCTA in the diagnosis of nAMD and other diseases, and its clinical application value has been recognized gradually.However, its application value in follow-up of patients with nAMD and polypoid choroidal vasculopathy (PCV) is still not well understood.By reviewing a large number of recent relevant literature on OCTA, and combining the clinical practice of our research team in monitoring the course of AMD and PCV disease by OCTA, we have gained new knowledge and understanding of the pathological mechanism of AMD and PCV.In this paper, we elucidated the latest understanding of the diagnostic value of OCTA in AMD based on long-term series of OCTA studies, the new findings of OCTA in AMD management of our team, as well as its impact on ophthalmology clinical practice.Then we forecasted the role of OCTA in the prediction of recurrence and anti-VEGF treatment response, as well as the clinical value of OCTA in the optimization of nAMD treatment and follow-up plan.It is recommended that clinicians pay more attention to the clinical value and guiding role of OCTA in long-term treatment monitoring and follow-up of AMD.

Polypoidal Choroidal Vasculopathy in Caucasians: Morphological Findings from Multimodal Retinal Imaging.

PURPOSE: The aim of the study was to characterize the morphological features of polypoidal choroidal vasculopathy (PCV) in a large Caucasian population. METHODS: We conducteda multicenter, cross-sectional study of treatment-naïve patients with PCV. Baseline fundus photography, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) were assessed by trained medical graders. Typical PCV features were explored, and retinal thickness (RT) and choroidal thickness (CT) measurements were performed. RESULTS: Seventy-nine eyes of 73 patients (mean age, 72.6 ± 11.9 years) were included. ICGA identified macular polyps in 89.9% of cases. SD-OCT revealed mostly subretinal fluid (93.6%) and a retinal pigment epithelium (RPE) detachment in 91.4%, with sharp protrusion in 67.0% of cases. Polyp-like structures were seen in 74.3% of cases, mostly adherent to an elevated RPE (69.6%). Type 1 neovascularization (NV) was identified in 74.7% of patients, while 16.5% had a mixed NV. The mean macular CT was 220.9 ± 83.2 µm (range, 67.9-403.6). Diffuse and focal pachychoroid were observed in 26.6 and 30.4% of patients, respectively. Soft drusen were reported in 62.0% of cases, but retinal hemorrhage occurred in only 19.0% of cases. CONCLUSION: The morphological features of PCV in Caucasians are similar to those reported in Asians. Pachychoroid signs were found in nearly half of our cohort. However, the mean age at presentation, high prevalence of soft drusen, and low prevalence of large subretinal hemorrhages make PCV closer to age-related macular degeneration in this ethnic group.

Optical coherence tomography angiography characteristics of choroidal neovascularizaiton in eyes with fiat irregular pigment epithelial detachments / 中华眼底病杂志

Objective To assess the occurrence of CNV in patients presenting with flat irregular pigment epithelial detachments (FIPED).Methods Forty-five patients (49 eyes) with FIPED on OCT were enrolled in this retrospective study.There were 25 males (28 eyes) and 20 females (21 eyes).The mean age was 61.022±9.292 years.FFA,ICGA,spectral domain OCT and OCT angiography (OCTA) were performed in all patients during the same period.The FIPED was defined as an irregular elevation of the RPE allowing distinct visualization of Bruch's membrane on OCT B-scan.The abnormal vascular signals from the deep retinal layer to the choroid layer on OCTA was defined as CNV.The CNV was classified into a type 1 CNV and a type 2 CNV according to the OCT characteristics.The CNV was classified into a typical and occult CNV according to the characteristics of the FFA image.Of all 49 eyes,fundus angiography revealed 18 eyes (36.7％) with CNV,and 31 eyes (63.3％) with no characteristic signs of CNV.FFA examination found that CNV in 8 eyes (classic CNV in 1 eyes,occult CNV in 7 eyes),which confirmed by OCT were type 1 CNV;transmitted fluorescence in 41 eyes.ICGA examination showed that CNV-like hyperfluorescence spots in 18 eyes,suspicious hyperfluorescence spots in late stage in 20 eyes,and choroidal high permeability in 11 eyes,respectively;and 18 CNV eyes were confirmed to be type 1 CNV by OCT.To compare the detection of CNV by OCTA and fundus angiography.Results Of the 49 eyes with FIPED,OCTA detected 36 eyes (73.5％) of type 1 CNV,and full or partial strong reflex signals were seen in FIPED;13 eyes (26.5％) were not associated with CNV,and some strong reflection signals were found in FIPED in 9 eyes,4 eyes with weak reflection signal.The FFA was examined for 1,7 eyes of the classic and occult CNV,which confirmed to be type 1 CNV by OCTA.Among the 18 eyes with CNV which detected by ICGA,OCTA also found type 1 CNV.Among the 20 eyes with ICGA's late suspicious strong fluorescent spots,OCTA showed 17 eyes of type 1 CNV;in 11 eyes with high choroidal permeability,OCTA showed type 1 CNV in 1 eye.Among the 36 eyes with CNV which detected by OCT,there were SRD in 32 eyes,no SRD in 2 eyes and retinal interlamellar cavities in 2 eyes.Conclusion OCTA can detect 73.5％ of FIPED eyes with CNV.Compared with traditional fundus angiography,OCTA has a higher detection rate of CNV under FIPED.The FIPED of the internal strong reflection signal has a certain diagnostic value for the type 1 CNV.

Re-understanding optical coherence tomography angiography / 中华眼底病杂志

As a new and non-invasive imaging technology,optical coherence tomography angiography (OCTA) has been using in ocular fundus diseases,glaucoma and neuro-ophthalmic disorders for more than 4 years.The most valuable and efficient application of OCTA is in detecting neovascular diseases in the macula.The big advantage of OCTA is for diagnosing all kinds of choroidal neovascularization.OCTA can observe blood flow information in different layers of the retina.To a large extent,it changes our diagnostic thinking and pathway in macular diseases.Before acquiring OCTA image,the operator should be well trained to ensure to get high quality images with good signal strength and less artifact.OCTA report should show the segmentation slab that the ophthalmologist wants to see.So far,OCTA has difficulty to reach peripheral retina with default setting.Even so,OCTA has provided much information of blood flow within retinal vascular arcade for evaluating structural and functional changes.We are expecting that the swept source OCTA could give us better observation of the choroidal blood flow.That should be the breakthrough of the new generation of OCTA.

Optical coherence tomography angiography and traditional multimodal fundus imaging in the diagnosis and activity evaluation of choroidal neovascularization in exudative age-related macular degeneration / 中华眼底病杂志

Objective To compare the consistency and difference of optical coherence tomography angiography (OCTA) and traditional multimodal fundus imaging in the diagnosis and activity evaluation of choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD). Methods A total of 112 exudative AMD patients (130 eyes) were included in this retrospective study, 62 were men (71 eyes) and 50 were women (59 eyes). The mean age was (68.250±9.789) years (range 50–91 years). All patients were underwent traditional multimodal fundus imaging including fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (OCT);OCTA was performed at the same time. The CNV type was divided into active and non-active according to the results of traditional multimodal fundus imaging. The vascular pattern was divided into active and non-active according to the results of OCTA. Using traditional multimodal fundus imaging as the standard, the sensitivity and specialty of OCTA was evaluated. Results In 130 eyes, CNV was visualized on traditional multimodal fundus imaging in 109 eyes (83.8%);CNV was visualized on OCTA in 103 eyes (79.2%), which including 7 eyes of false negative and 1 eye of false positive. The sensitivity of OCTA for CNV diagnosis was 93.6%, with specificity of 95.2%. The CNV detection rate between two methods had no significant difference (Youden index=0.89, Kappa value=0.796, P=0.07). In 109 eyes diagnosed with CNV by traditional multimodal fundus imaging, 73 eyes (67.0%) were active CNV and 36 eyes (33.0%) were non-active CNV;the vascular pattern was active in 60 eyes (55.0%) and non-active in 49 eyes (45.0%). The sensitivity of OCTA for the detection of active CNV was 82.2%, with specificity of 100.0%. The active CNV detection rate between two methods had no significant difference (Youden index=0.82, Kappa value=0.753, P=0.00). Conclusion In the diagnosis and activity evaluation of CNV in exudative AMD, there is remarkable consistency between OCTA and traditional multimodal fundus imaging.

Pachychoroid spectrum diseases / 中华眼底病杂志

Pachychoroid spectrum diseases includes central serous chorioretinopathy (CSC),pachychoroid pigment epitheliopathy,pachychoroid neovasculopathy,and polypoidal choroidal vasculopathy,which share common characteristics,including focal or diffused increased choroidal thickness,choroidal hyperpermeability,and dilated choroidal vessels.These diseases are likely to represent a continuum of the same pathogenic process.Similar features and association among them suggest that they may have similar etiology.It is of great clinical significance to understand the composition and typical morphological changes of pachychoroid-related diseases and to explore its possible pathogenesis.

Clinical values of OCT angiography in imaging of chroidal neovascularization in pathological myopic maculopathy / 中华实验眼科杂志

Background Myopic maculopathy leads to visual function damage.Conventional methods for the identification of choroidal neovascularization (CNV) of myopic maculopathy are fundus fluorescine angiography (FFA) and spectral-domain OCT (SD-OCT),but FFA is an invasive process and SD-OCT is incapable to image CNV well.OCT angiography (OCTA),a novel and non-invasive vascular technique,appears to be dominant in enface imaging of CNV,however,its clinical value remains to be evaluated.Objective This study was to evaluate the application of OCTA in imaging CNV of myopic maculopathy.Methods A prospective serial cases-observational study was performed.Forty-two eyes of 40 patients of myopic maculopathy were included in Ophthalmic Center,Renmin Hospital of Wuhan University from January to October 2015,with the diopter (-10.5 ± 3.74) D.Comperehensive optical and imaginal examinations were carried out in all the eyes,including fundus photography,FFA,SD-OCT and OCTA.Ranibizumab (0.5 mg/0.05 ml) was intravitreally injected in 35 eyes of 35 patients under the informed consent and SD-OCT and OCTA were examined 1 day,1 week and subsequent each month after injection.FFA was examined 1 month after injection.The patients were followed-up for 1-6 months to evaluate the clinical values of OCTA in monitoring the CNV of myopic maculopathy.This study followed the Helsinki Declaration and was approved by the Ethics Committee of Renmin Hospital of Wuhan University.Written informed consent was obtained from each patient prior to any medical examination.Results All the affected eyes showed dye leakage in CNV lesions by FFA and high reflection signal of abnormal choroidal vascular network throughout retinal pigment epithelium by SD-OCT.Clusters of high signal CNV image was clearly visible in the lesions by OCTA,and these signals were able to be displayed on both choriocapillary layer and outer layer of retina more clearly than FFA in 31 eyes of 31 patients.In 35 eyes of 35 patients received intravitreal injection of ranibizumab,CNV images on both choriocapillary layer and outer layer of retina from OCTA shrinked 1 week after injection and the lesions were stable 1 month after injection.Conclusions OCTA can display CNV of myopic maculopathy on the retinal outer layer and choriocapillary layer more clearly than FFA.Significant changes in the CNV net can be observed by OCTA 1 week after intravitreal injection of ranibizumab.OCTA plays an important role during the following-up of CNV therapy.

Choroidal neovascularization secondary to pathologic myopia: a recent update on diagnosis and treatment / 中华眼底病杂志

Pathological myopia can induce choroidal neovascularization (PM-CNV).The potential risk factors include ageing,long axial length of the eyeball,thinning of subfoveal choroidal thickness,fundus atrophy spot and lacquer crack.These factors may induce atrophy of retinal pigment epithelial cells (RPE) and hypoxia,resulting in vascular endothelial growth factors (VEGF) secretion by outer retina.The lesion type,location and activity of PM-CNV can be determined by fundus fluorescein angiography.The features of PM-CNV on optical coherence tomography include strong reflective area close to RPE with very small amount of subretinal fluid (active stage),surface strong reflection with signal attenuation area (scar stage) and flat lesion and chorioretinal atrophy (atrophy stage).Photodynamic therapy and intravitreal injection of anti-VEGF drugs are major treatments for PM-CNV,the latter is more commonly used now.However,more large randomized controlled studies are required to explore the treatment regimen (such as frequency,indications for repeated or termination of treatment) and the efficacy factors further.

Quantitative analysis of choroidal neovascularization by split spectrum amplitude decorrelation angiography OCT / 中华实验眼科杂志

Background Choroidal neovascularization (CNV) is a major cause of visual loss in many fundus diseases.Fundus angiography (FA) is essential for the diagnosis,location and treatment of CNV.However, FA is an invasive examination method.Split spectrum amplitude decorrelation angiography (SSADA) OCT can quickly and clearly provide vascular signals.However, whether SSADA-OCT is feasible in the evaluation of CNV remains unclear.Objective This study was to detect and quantify CNV using OCT angiography.Methods Thirteen patients with unilateral CNV were included in Beijing Tongren Eye Center from June 2014 to August 2014.All affected eyes of the subjects were scanned with a high-speed frequency domain OCT.The SSADA-OCT images were obtained by scanning of macula covered 6 mm×6 mm area.The CNV area and grey scale were computed from the en face OCT images of retinal layer and choroidal layer.This study followed the Helsinki Declaration and was approved by the Ethics Committee of Beijing Tongren Hospital,and written informed consent was obtain from each patient prior to any medical examination.Results SSADA-OCT angiogram revealed CNV area and location confirmed by fluorescein angiography,and the CNV blood flow information of internal limiting membrane,inner plexiform layer,retinal pigment epithelium,and choroid was exhibited by OCT angiography.All CNVs with different causes showed the well defined and hyperreflected signal in macular region.The average CNV area was (0.15 ±0.09)mm2 , and the average grey scale of CNV was 75.40±32.35 in the affected eyes,and that in the contralateral eyes was 26.99±22.87 in the 300 μm area,showing significant elevation in gray scale in the affected eyes compared with the contralateral eyes (t =6.946, P＜0.001).Conclusions OCT angiography is a noninvasive observation technique of retinal and choroidal blood flow.It can provide quantitative information and detailed images of CNV.

Relationship between choroidal neovascularization and macular choroidal watershed zones in patients with age-related macular degeneration / 中华眼底病杂志

ObjectiveTo investigate the possible relationship between choroidal neovascularization (CNV) and macular choroidal watershed zones (CWZ) in patients with age-related macular degeneration (AMD). MethodsFifty-seven selected indocyanine green video angiograms (ICGA) of 57 patients (57 eyes) with AMD were evaluated, and 35 ones of the healthy fellow eyes of 35 patients with unilateral non-AMD fundus diseases were selected as age-matched control. The video angiograms were evaluated for investigating the relationship between CNV and macular CWZ. ResultsIn 57 eyes with AMD, 35 (61.4%) had macular CWZ, while in 35 control patients only 3 (8.57% ) had. The difference was significant (P