Oct angiography compared to fluorescein angiography, indocyanine green angiography and optical coherence tomography in the detection of choroidal neovascularization in pigment epithelial detachment

Blue-light fundus autofluorescence imaging of pigment epithelial detachments

BACKGROUND

Pigment epithelial detachments (PEDs) occur in association with various chorioretinal diseases. With respect to the broad clinical spectrum of PEDs we describe fundus autofluorescence (FAF) characteristics of PEDs.

METHODS

Ninety-three eyes of 66 patients (mean age 71.9 ± 11.1) with uni- or bilateral PED ( ≥ 350 µm) were included in a retrospective cross-sectional study. PEDs were secondary to age-related macular degeneration (n = 79), central serous chorioretinopathy (n = 7), polypoidal choroidal vasculopathy (n = 2), pattern dystrophy (n = 3) or idiopathic PED (n = 2). FAF images were recorded using confocal scanning laser ophthalmoscopy (488 nm excitation wavelength, detection of emission >500 nm). Diagnosis of PED was confirmed using spectral-domain optical coherence tomography. A qualitative FAF grading system was established, and grading was performed by two independent readers.

RESULTS

PEDs showed highly variable characteristics on FAF imaging. FAF within the area of PED was found to be irregular/granular (n = 59, 63.4%), increased (n = 28, 30.1%), decreased (n = 3, 3.2 %), or normal (n = 3, 3.2%). Accompanying FAF changes included condensation of macular pigment (n = 67, 72.0%), focally increased FAF at the PED apex (n = 14, 15.1%) or elsewhere (n = 52, 55.9%), focally decreased FAF (n = 23, 24.7%), a cartwheel-like pattern (n = 10, 10.8%), a doughnut sign (n = 6, 6.5%), and a halo of decreased FAF encircling the PED (completely n = 20, 21.5% or incompletely n = 20, 21.5%).

CONCLUSIONS

PEDs show a variety of abnormal patterns on FAF imaging. These changes in FAF signals may be secondary to morphological and metabolic alterations within corresponding retinal layers and do not necessarily correspond with the underlying PED subtype or a specific pathology.

Gold Nanorod Enhanced Photoacoustic Microscopy and Optical Coherence Tomography of Choroidal Neovascularization

Visualization and evaluation of choroidal neovascularization (CNV) are major challenges to improve treatment outcomes for patients with age-related macular degeneration (AMD). Limitations of current imaging techniques include the limited penetration depth, spatial resolution, and sensitivity and difficulty visualizing CNV from the healthy microvasculature. In this study, a custom-built multimodal photoacoustic microscopy (PAM) and optical coherence tomography (OCT) system was developed to distinguish the margin of CNV in living rabbits with the assistance of functionalized gold nanorods conjugating with RGD ligands (GNR-RGD). Intravenous administration of GNR-RGD into rabbits in a CNV model resulted in signal enhancements of 27.2-fold in PAM and 171.4% in OCT. This molecular imaging technique of contrast-enhanced PAM and OCT is a promising tool for the precise imaging of CNV as well as the evaluation of the pathophysiology in vivo without destruction of tissue.

Diagnostic accuracy of optical coherence tomography angiography for choroidal neovascularization: a systematic review and meta-analysis

BACKGROUND

Optical coherence tomography angiography (OCTA), an innovative image technique, renders visualization of ocular neovascularization through non-invasive means, which has been applied in recent years. Therefore, the present study was designed to assess the diagnostic value of OCTA in detecting the choroidal neovascularization (CNV).

METHODS

In brief, PubMed, Web of Science and Cochrane Library databases were systematically searched from January 2014 to June 2019. Afterwards, a meta-analysis was performed to determine the pooled diagnostic accuracy in a random-effects model using STATA 15.1 and Meta-Disc 1.4 software. Quality Assessment of diagnostic Accuracy Version 2 was used to evaluate the risk of bias of each study by Revman 5.3 software. In addition, a meta-regression model was further conducted to explore potential sources of heterogeneity.

RESULTS

According to pre-set inclusion and exclusion criteria, 16 eligible studies were enrolled in this study. A total of 447 CNV eyes and 414 non-CNV eyes were included to investigate the diagnostic accuracy of OCTA. As a result, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (PLR), diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristic curve (sROC-AUC) were 0.87 (95% CI 0.81-0.92), 0.97 (95% CI 0.92-0.99), 32.7 (95% CI 10.1-105.5), 0.13 (95% CI 0.08-0.20), 252 (95% CI 63-1011) and 0.96 (95% CI 0.94-0.97), respectively.

CONCLUSIONS

In summary, we demonstrated that OCTA was of high diagnostic value for detecting intraocular CNV.