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Rajabi MT, Sadeghi R, Abdol Homayuni MR, Pezeshgi S, Hosseini SS, Rajabi MB, Poshtdar S. Optical coherence tomography angiography in thyroid associated ophthalmopathy: a systematic review. BMC Ophthalmol 2024; 24:304. [PMID: 39039451 PMCID: PMC11265183 DOI: 10.1186/s12886-024-03569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE To evaluate the evidence for alterations of blood flow, vascular and perfusion densities in the choroid, macula, peripapillary region, and the area surrounding the optic nerve head (ONH) in patients with thyroid-associated ophthalmopathy (TAO) based on changes of OCTA parameters. METHODS A systematic review of Pubmed, Google Scholar, Scopus, WOS, Cochrane, and Embase databases, including quality assessment of published studies, investigating the alterations of OCTA parameters in TAO patients was conducted. The outcomes of interest comprised changes of perfusion and vascular densities in radial peripapillary capillary (RPC), ONH, superficial and deep retinal layers (SRL and DRL), choriocapillaris (CC) flow, and the extent of the foveal avascular zone (FAZ). RESULTS From the total of 1253 articles obtained from the databases, the pool of papers was narrowed down to studies published until March 20th, 2024. Lastly, 42 studies were taken into consideration which contained the data regarding the alterations of OCTA parameters including choriocapillary vascular flow, vascular and perfusion densities of retinal microvasculature, SRL, and DRL, changes in macular all grid sessions, changes of foveal, perifoveal and parafoveal densities, macular whole image vessel density (m-wiVD) and FAZ, in addition to alterations of ONH and RPC whole image vessel densities (onh-wiVD and rpc-wiVD) among TAO patients. The correlation of these parameters with visual field-associated parameters, such as Best-corrected visual acuity (BCVA), Visual field mean defect (VF-MD), axial length (AL), P100 amplitude, and latency, was also evaluated among TAO patients. CONCLUSION The application of OCTA has proven helpful in distinguishing active and inactive TAO patients, as well as differentiation of patients with or without DON, indicating the potential promising role of some OCTA measures for early detection of TAO with high sensitivity and specificity in addition to preventing the irreversible outcomes of TAO. OCTA assessments have also been applied to evaluate the effectiveness of TAO treatment approaches, including systemic corticosteroid therapy and surgical decompression.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Zip Code: 1336616351, Tehran, Iran
| | - Reza Sadeghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Zip Code: 1336616351, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Abdol Homayuni
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Zip Code: 1336616351, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Pezeshgi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Zip Code: 1336616351, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Simindokht Hosseini
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Zip Code: 1336616351, Tehran, Iran
| | - Mohammad Bagher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Zip Code: 1336616351, Tehran, Iran
| | - Sepideh Poshtdar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Zip Code: 1336616351, Tehran, Iran.
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Chen N, Zhu Z, Yang W, Wang Q. Progress in clinical research and applications of retinal vessel quantification technology based on fundus imaging. Front Bioeng Biotechnol 2024; 12:1329263. [PMID: 38456011 PMCID: PMC10917897 DOI: 10.3389/fbioe.2024.1329263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Retinal blood vessels are the only directly observed blood vessels in the body; changes in them can help effective assess the occurrence and development of ocular and systemic diseases. The specificity and efficiency of retinal vessel quantification technology has improved with the advancement of retinal imaging technologies and artificial intelligence (AI) algorithms; it has garnered attention in clinical research and applications for the diagnosis and treatment of common eye and related systemic diseases. A few articles have reviewed this topic; however, a summary of recent research progress in the field is still needed. This article aimed to provide a comprehensive review of the research and applications of retinal vessel quantification technology in ocular and systemic diseases, which could update clinicians and researchers on the recent progress in this field.
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Affiliation(s)
- Naimei Chen
- Department of Ophthalmology, Huaian Hospital of Huaian City, Huaian, China
| | - Zhentao Zhu
- Department of Ophthalmology, Huaian Hospital of Huaian City, Huaian, China
| | - Weihua Yang
- Department of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Qiang Wang
- Department of Ophthalmology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, China
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Lee S, You DH, Park S, Oh HS, Kwon OW. Distribution of Neurofilament in Peeled Internal Limiting Membrane. Ophthalmic Surg Lasers Imaging Retina 2023; 54:643-648. [PMID: 37956316 DOI: 10.3928/23258160-20231011-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim was to study the distribution of neurofilament in peeled internal limiting membrane (ILM). PATIENTS AND METHODS Prospective case study. Vitrectomy and ILM peeling were performed in patients with epiretinal membrane and macular hole. ILM flap specimens were obtained as one disc area size from five locations. Immunofluorescent staining was performed with an antineurofilament heavy antibody. Using a confocal microscope, retinal cell debris density was studied using the ImageJ program. RESULTS Percent of stained neurofilament was 1.58 ± 1.14% in total (2.45 ± 1.37% in extranasal, 1.97 ± 0.75% in extratemporal, 1.93 ± 1.26% in juxta-nasal, 0.89 ± 0.69% in fovea, and 0.63 ± 0.46% in juxtatemporal). The Kruskal-Wallis test revealed significant differences among groups (P < 0.05). Bonferroni post hoc analysis only confirmed significant difference between juxtatemporal and extranasal groups (P < 0.05). CONCLUSIONS In peeled ILM flap, neurofilaments are rarely detected in the juxtatemporal area. However, they are frequently detected in the extranasal area. [Ophthalmic Surg Lasers Imaging Retina 2023;54:643-648.].
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Chandran K, Giridhar A, Gopalakrishnan M, Sivaprasad S. Relation of interdigitation zone changes and right-angle vessels in Macular Telangiectasia Type-2 (MacTel). Eye (Lond) 2023; 37:2977-2986. [PMID: 36841866 PMCID: PMC10516857 DOI: 10.1038/s41433-023-02453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND To study the relation between interdigitation zone (IDZ) and right-angle vessel (RAV) in Macular Telangiectasia Type-2 (MacTel). METHODS A total of 43 eyes of 38 patients with presence of definite RAV on colour fundus photograph (Gass and Blodi-only stage-3) were confirmed on multimodal imaging. The relation of IDZ changes and associated ellipsoid zone (EZ) alterations on spectral-domain optical coherence tomography (OCT) with RAV were studied at baseline and these OCT changes were followed up in 15 eyes over a mean of 3.86 years. RESULTS A total of 58 RAVs were found in the 43 eyes and 53/58 (91.3%) RAVs were associated with IDZ alterations in 39 eyes. On follow-up, IDZ attenuation progressed to IDZ loss and subsequent EZ attenuation and loss. A pre-existing IDZ loss was associated with subsequent EZ defect (P = 0.002). In 36 eyes that had OCT angiography, eyes with RAV showed deep capillary plexus telangiectasia in all 36 (100%) eyes and 32/36 (89%) eyes showed IDZ changes with or without EZ loss. CONCLUSIONS IDZ attenuation and/or loss are associated with RAV and may serve as predictor of EZ loss in MacTel.
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Affiliation(s)
- Kiran Chandran
- Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, Kerala, India
- SSM Eye Research Foundation, Giridhar Eye Institute, Cochin, Kerala, India
| | - Anantharaman Giridhar
- Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, Kerala, India.
- SSM Eye Research Foundation, Giridhar Eye Institute, Cochin, Kerala, India.
| | | | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Erol MK, Gedik B, Bozdogan YC, Ekinci R, Bulut M, Dogan B, Suren E, Akidan M. Evaluation of Optic Disc, Retinal Vascular Structures, and Acircularity Index in Patients with Idiopathic Macular Telangiectasia Type 2. Diagnostics (Basel) 2023; 13:3046. [PMID: 37835789 PMCID: PMC10572724 DOI: 10.3390/diagnostics13193046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND We aimed to compare the retinal, optic disc vascular density (ODVD) values, and acircularity index (AI) of patients with idiopathic macular telangiectasia type 2 (IMT) and healthy individuals using the optical coherence tomography angiography (OCTA) device. METHODS The study included 39 patients with IMT and 37 healthy controls. The OCTA findings of the patients and controls were examined. RESULTS The total, parafoveal and perifoveal vascular density of the superficial capillary plexus, choriocapillaris blood flow, inside-disc ODVD, retinal nerve fiber layer (RNFL), and retinal thicknesses were found to be statistically significantly lower, and the foveal avascular zone value was statistically significantly higher in the IMT group compared to the control group (p = 0.001, p = 0.01, p = 0.02, p = 0.01, p = 0.009, p = 0.002, p = 0.02, respectively). There was a statistically significant negative correlation between best-corrected visual acuity (BCVA) and AI (p = 0.02), and a statistically significant positive correlation between peripapillary vascular density and BCVA (p = 0.04). CONCLUSIONS We consider that the lower retinal, choriocapillaris, ODVD values, and retinal and RNFL thicknesses in the patients with IMT compared to the controls were due to vascular damage, remodeling, fibrosis, proliferation, and Müller cell damage. Ellipsoid zone defect, AI, and peripapillary vascular density are important indicators in the evaluation of visual acuity in these patients.
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Affiliation(s)
- Muhammet Kazim Erol
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Birumut Gedik
- Department of Ophthalmology, Serik State Hospital, 07500 Antalya, Turkey;
| | - Yigit Caglar Bozdogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Rojbin Ekinci
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Mehmet Bulut
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Berna Dogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Elcin Suren
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Melih Akidan
- Department of Ophthalmology, Kepez State Hospital, 07320 Antalya, Turkey;
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Batıoğlu F, Yanık Ö, Demirel S, Özmert E. Clinical Use of Optical Coherence Tomography Angiography in Retinal Diseases. Diagnostics (Basel) 2023; 13:diagnostics13101820. [PMID: 37238303 DOI: 10.3390/diagnostics13101820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
The advent of optical coherence tomography angiography (OCTA) is one of the cornerstones of fundus imaging. Essentially, its mechanism depends on the visualization of blood vessels by using the flow of erythrocytes as an intrinsic contrast agent. Although it has only recently come into clinical use, OCTA has become a non-invasive diagnostic tool for the diagnosis and follow-up of many retinal diseases, and the integration of OCTA in multimodal imaging has provided a better understanding of many retinal disorders. Here, we provide a detailed overview of the current applications of OCTA technology in the diagnosis and follow-up of various retinal disorders.
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Affiliation(s)
- Figen Batıoğlu
- Department of Ophthalmology, Ankara University School of Medicine, 06620 Ankara, Turkey
| | - Özge Yanık
- Department of Ophthalmology, Ankara University School of Medicine, 06620 Ankara, Turkey
| | - Sibel Demirel
- Department of Ophthalmology, Ankara University School of Medicine, 06620 Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Ankara University School of Medicine, 06620 Ankara, Turkey
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Zhang L, Van Dijk EHC, Borrelli E, Fragiotta S, Breazzano MP. OCT and OCT Angiography Update: Clinical Application to Age-Related Macular Degeneration, Central Serous Chorioretinopathy, Macular Telangiectasia, and Diabetic Retinopathy. Diagnostics (Basel) 2023; 13:diagnostics13020232. [PMID: 36673042 PMCID: PMC9858550 DOI: 10.3390/diagnostics13020232] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Similar to ultrasound adapting soundwaves to depict the inner structures and tissues, optical coherence tomography (OCT) utilizes low coherence light waves to assess characteristics in the eye. Compared to the previous gold standard diagnostic imaging fluorescein angiography, OCT is a noninvasive imaging modality that generates images of ocular tissues at a rapid speed. Two commonly used iterations of OCT include spectral-domain (SD) and swept-source (SS). Each comes with different wavelengths and tissue penetration capacities. OCT angiography (OCTA) is a functional extension of the OCT. It generates a large number of pixels to capture the tissue and underlying blood flow. This allows OCTA to measure ischemia and demarcation of the vasculature in a wide range of conditions. This review focused on the study of four commonly encountered diseases involving the retina including age-related macular degeneration (AMD), diabetic retinopathy (DR), central serous chorioretinopathy (CSC), and macular telangiectasia (MacTel). Modern imaging techniques including SD-OCT, TD-OCT, SS-OCT, and OCTA assist with understanding the disease pathogenesis and natural history of disease progression, in addition to routine diagnosis and management in the clinical setting. Finally, this review compares each imaging technique's limitations and potential refinements.
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Affiliation(s)
- Lyvia Zhang
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, 20132 Milan, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, Department NESMOS, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy
| | - Mark P. Breazzano
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY 13088, USA
- Correspondence: ; Tel.: +1-(315)-445-8166
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Venkatesh R, Reddy NG, Mishra P, Yadav NK, Chhablani J. Structural-vascular-functional correlation in type 2 non-proliferative macular telangiectasia. Int J Retina Vitreous 2022; 8:59. [PMID: 36028918 PMCID: PMC9419364 DOI: 10.1186/s40942-022-00410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To correlate the structural-vascular-functional changes in type 2 non-proliferative macular telangiectasia (MacTel) using optical coherence tomography (OCT) angiography (OCTA). METHODS In this retrospective study, OCTA and enface OCT image analysis of eyes with confirmed diagnosis of non-proliferative type 2 MacTel was performed. The 'MacTel area' was calculated by marking the outer boundary of an area affected by MacTel on superficial (SCP) and deep capillary plexus (DCP) on OCTA images and photoreceptor layer (PRL) on enface OCT scan. At every follow-up OCTA scan visit, best-corrected visual acuity, MacTel area and stage of disease was documented. Analyses between disease stage, MacTel area and logMAR visual acuity was carried out. RESULTS In total, 38 single-visit OCTA scans of 22 patients were included. The mean age was 58.9 ± 10.98 years. An increase in disease severity stage correlated positively with MacTel area in SCP segmentations slab (r = 0.334; p = 0.04) and logMAR visual acuity (r = 0.338; p = 0.038). No correlation in the DCP area or PRL area (p > 0.05) was noted with disease stage. A statistically significant positive correlation was noted between the structural changes in PRL layer with vascular changes in SCP (p = 0.021) but not in DCP (p = 0.199). No correlation of visual acuity with changes in SCP, DCP or PRL was noted (p > 0.05). CONCLUSION OCTA is a useful adjunct for determining disease severity in type 2 non-proliferative MacTel by assessing the structural-vascular changes. Further longitudinal studies need to be considered in future for understanding the pathomechanism of retinal damage in type 2 MacTel.
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Affiliation(s)
- Ramesh Venkatesh
- Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India. .,Deptartment of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India.
| | - Nikitha Gurram Reddy
- Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Pranjal Mishra
- Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Naresh Kumar Yadav
- Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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Moir J, Amin SV, Khanna S, Komati R, Shaw LT, Dao D, Hariprasad SM, Skondra D. Use of OCT Angiography to Diagnose and Manage Atypical Presentations of Macular Telangiectasia Type 2. Int J Mol Sci 2022; 23:7849. [PMID: 35887197 PMCID: PMC9321649 DOI: 10.3390/ijms23147849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022] Open
Abstract
Macular telangiectasia Type 2 (MacTel) is a bilateral acquired retinal disease characterized by both vascular changes and atrophy of the retina. The purpose of this case series is to highlight the use of optical coherence tomography angiography (OCTA) as a non-invasive imaging modality to distinguish atypical MacTel from other macular conditions with similar presentations. We performed a retrospective review of patients referred to our academic retinal practice with unconfirmed or misdiagnosed MacTel between July 2017 and July 2021. Patients' OCTA imaging findings were reviewed to guide the appropriate diagnosis and management of atypical MacTel. Fifteen eyes from eight patients were included in this study. Six patients were referred with previous diagnoses of either full-thickness macular hole, lamellar hole, vitreomacular traction (VMT), postoperative cystoid macular edema (CME), or diabetic macular edema (DME). Two patients were referred to us to confirm the diagnosis of MacTel. OCTA revealed telangiectatic vessels in the temporal parafovea of all 15 eyes. OCTA also highlighted previously undiagnosed subretinal neovascularization (SRNV) in seven eyes. OCTA imaging is a valuable imaging modality to distinguish MacTel from other macular conditions, whose treatment courses vary substantially. Due to its ease of use, it holds immense potential in the future as treatments for non-proliferative MacTel emerge.
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Affiliation(s)
- John Moir
- Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA;
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (S.V.A.); (S.K.); (R.K.); (L.T.S.); (D.D.); (S.M.H.)
| | - Shivam V. Amin
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (S.V.A.); (S.K.); (R.K.); (L.T.S.); (D.D.); (S.M.H.)
| | - Saira Khanna
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (S.V.A.); (S.K.); (R.K.); (L.T.S.); (D.D.); (S.M.H.)
| | - Rahul Komati
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (S.V.A.); (S.K.); (R.K.); (L.T.S.); (D.D.); (S.M.H.)
- Georgia Retina, Stockbridge, GA 30281, USA
| | - Lincoln T. Shaw
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (S.V.A.); (S.K.); (R.K.); (L.T.S.); (D.D.); (S.M.H.)
| | - David Dao
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (S.V.A.); (S.K.); (R.K.); (L.T.S.); (D.D.); (S.M.H.)
| | - Seenu M. Hariprasad
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (S.V.A.); (S.K.); (R.K.); (L.T.S.); (D.D.); (S.M.H.)
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (S.V.A.); (S.K.); (R.K.); (L.T.S.); (D.D.); (S.M.H.)
- J. Terry Ernest Ocular Imaging Center, University of Chicago Medical Center, Chicago, IL 60637, USA
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One-year follow-up of optical coherence tomography angiography microvascular findings: macular telangiectasia type 2 versus tamoxifen retinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3479-3488. [PMID: 35536356 DOI: 10.1007/s00417-022-05695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/15/2022] [Accepted: 04/30/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To compare microstructural and microvascular changes in eyes with macular telangiectasia type 2 (MacTel2) and in those with tamoxifen retinopathy (TR) at baseline and at the 1-year follow-up using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS We followed up patients diagnosed with MacTel2 or TR for at least 1 year. We included 17 patients with MacTel2 (31 eyes) and 15 with TR (25 eyes) who discontinued tamoxifen use after a TR diagnosis. We performed OCT and OCTA at baseline and after 1 year. RESULTS Patients with MacTel2 and TR showed intraretinal cavitation, ellipsoid zone (EZ) loss, and capillary telangiectasia in the superficial and deep plexuses. EZ disruption predominantly affected the temporal region in MacTel2 (32%) and was limited to the foveal center in TR (24%). Vascular density (VD) was significantly reduced within the deep temporal parafovea and superficial fovea in MacTel2 and TR eyes, respectively. After 1 year, the MacTel2 eyes showed enlarged EZ loss, proliferative vascular invasion, and increased VD (p = 0.021) in the temporal deep plexus compared with TR eyes. CONCLUSIONS After 1-year follow-up, the MacTel2 eyes showed proliferative vascular remodeling, particularly in the temporal parafovea of the deep plexus with EZ loss progression, whereas the TR eyes maintained their baseline capillary rarefaction.
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Foulsham W, Chien J, Lenis TL, Papakostas TD. Optical Coherence Tomography Angiography: Clinical Utility and Future Directions. JOURNAL OF VITREORETINAL DISEASES 2022; 6:229-242. [PMID: 37008547 PMCID: PMC9976135 DOI: 10.1177/24741264221080376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose This work aims to review the principles of optical coherence tomography angiography (OCTA), to survey its clinical utility, and to highlight the strengths of this technology as well as barriers to adoption. Methods A literature review with editorial discussion of the current applications for OCTA is presented. Results There have been recent advances in multiple domains in OCTA imaging, including devices, algorithms, and new observations pertaining to a range of pathologies. New devices have improved the scanning speed, signal-to-noise ratio, and spatial resolution and offer an increased field of view. New algorithms have been proposed to optimize image processing and reduce artifacts. Numerous studies employing OCTA have been published describing changes to the microvasculature in diabetic retinopathy, age-related macular degeneration, central serous chorioretinopathy, retinal vein occlusion, and uveitis. Conclusions OCTA provides noninvasive, high-resolution volumetric scans of the retinal and choroidal vasculature. OCTA can provide valuable data to augment traditional dye-based angiography in a range of chorioretinal diseases.
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Affiliation(s)
- William Foulsham
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
| | - Jason Chien
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
| | - Tamara Lee Lenis
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
| | - Thanos D. Papakostas
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
- The Retina Institute, St Louis, MO, USA
- Thanos D. Papakostas, MD, The Retina Institute, 2201 S Brentwood Blvd, St Louis, MO 63144, USA.
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Wiest MRJ, Bajka A, Hamann T, Foa N, Toro M, Barthelmes D, Zweifel S. Differences in Mean Values and Variance in Quantitative Analyses of Foveal OCTA Imaging. Klin Monbl Augenheilkd 2022; 239:513-517. [PMID: 35472795 DOI: 10.1055/a-1766-7268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Multiple approaches for quantifying parameters such as vessel density (VD) and vessel length density (VLD) in optical coherence tomography angiography (OCTA) en-face segmentations are currently available. While it is common knowledge that data gathered from different methods should not be directly compared to each other, a comparison of the different methods can help to further the understanding of differences between different methods of measurement. Here we compare a common method of semiautomatically quantifying VD and VLD with an automated method supplied by the manufacturer of an OCTA device and report on differences in performance in order to probe for and highlight differences in values gathered by both methods. METHODS OCTA was performed using the swept source PLEX Elite 9000 device, software version 2.0.1.47652 (Carl Zeiss Meditec Inc., Dublin, CA, USA). Scans of 3 mm × 3 mm from healthy volunteers centred on the fovea were acquired by a well-trained certified ophthalmologist. Scans with a signal strength of 8 out of 10 or higher were included. Quantitative parameters of the 3 mm × 3 mm cube scans were automatically generated and segmented into superficial capillary plexus (SCP) and deep capillary plexus (DCP) layers using layer segmentation produced by the instrument software and prototype analysis VD quantification software (Macular Density v.0.7.1, ARI Network Hub, Carl Zeiss Meditec Inc., Dublin, CA, USA) supplied by the manufacturer. An alternative approach of quantitative analysis of VD and VLD was performed manually with ImageJ (National Institutes of Health, Bethesda, Maryland, USA), as previously reported. VD was assessed as the ratio of the retinal area occupied by vessels. VDL was measured as the total length of the skeletonised vessels using 1-pixel centre line extraction of the blood vessels. RESULTS We report differences in standard deviation (SD) in OCTA parameters obtained using different methods. The standard deviation of VD and VLD measurements was statistically significantly different in VD of 3 mm × 3 mm DCP (p = 0.009), VLD of 3 mm × 3 mm SCP (p = 0.000), and VLD of 3 mm × 3 mm DCP (p = 0.021). No statistically significant differences were found in VD of 3 mm × 3 mm SCP (p = 0.128) or VLD of 3 mm × 3 mm SCP (p = 0.107). CONCLUSIONS As expected, we were able to demonstrate significant differences in quantitative OCTA parameters gathered from the same images using different methods of quantification. Values gathered using different methods are not interchangeable. In scientific studies and in situations where long-term follow-up is necessary, the same device and the same method of quantification should be used to maintain retrospective comparability of measurements.
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Affiliation(s)
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Timothy Hamann
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Nastasia Foa
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Mario Toro
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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13
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Hormel TT, Hwang TS, Bailey ST, Wilson DJ, Huang D, Jia Y. Artificial intelligence in OCT angiography. Prog Retin Eye Res 2021; 85:100965. [PMID: 33766775 PMCID: PMC8455727 DOI: 10.1016/j.preteyeres.2021.100965] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022]
Abstract
Optical coherence tomographic angiography (OCTA) is a non-invasive imaging modality that provides three-dimensional, information-rich vascular images. With numerous studies demonstrating unique capabilities in biomarker quantification, diagnosis, and monitoring, OCTA technology has seen rapid adoption in research and clinical settings. The value of OCTA imaging is significantly enhanced by image analysis tools that provide rapid and accurate quantification of vascular features and pathology. Today, the most powerful image analysis methods are based on artificial intelligence (AI). While AI encompasses a large variety of techniques, machine-learning-based, and especially deep-learning-based, image analysis provides accurate measurements in a variety of contexts, including different diseases and regions of the eye. Here, we discuss the principles of both OCTA and AI that make their combination capable of answering new questions. We also review contemporary applications of AI in OCTA, which include accurate detection of pathologies such as choroidal neovascularization, precise quantification of retinal perfusion, and reliable disease diagnosis.
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Affiliation(s)
- Tristan T Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA.
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14
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Venkatesh R, Reddy NG, Mishra P, Pereira A, Mutalik D, Agrawal S, Bhatt A, Yadav NK, Chhablani J. The preproliferative stage in type 2 macular telangiectasia (MacTel type 2). Graefes Arch Clin Exp Ophthalmol 2021; 260:121-132. [PMID: 34410484 DOI: 10.1007/s00417-021-05371-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To study clinical and imaging features of various stages of macular telangiectasia (MacTel type 2). METHODS In this retrospective study, cases of MacTel type 2 with fluorescein angiography (FA), optical coherence tomography (OCT) and OCT-angiography (OCTA) imaging were included. Based on angiographic perifoveal fluorescence, two groups were formed: group 1: diffuse hyperfluoroscence and group 2: diffuse + focal hyperfluoroscence. Later, based on OCT features, group 2 was subdivided into group 2A: without SRNVM and group 2B: with SRNVM. Clinical, FA, OCT and OCTA features were analysed. Eyes showing conversion to the proliferative stage at final visit were noted. RESULTS Ninety-four eyes of 48 patients were included. Group 1 (n = 28) showed diffuse perifoveal hyperfluoroscence, hyperreflective middle retinal layers, absent SRNVM (p = 0.006) on OCT and dilated perifoveal capillaries in deep capillary plexus (DCP) on OCTA. Group 2A (n = 40) showed diffuse + focal perifoveal hyperfluoroscence, hyperreflective middle retinal layers (p = 0.001), hyporeflective outer retina cavities (p = 0.021), absent SRNVM with dilated and bunching perifoveal capillaries (p = 0.004) in DCP. Group 2B (n = 26) showed late diffuse + focal perifoveal hyperfluoroscence, foveal contour irregularity (p = 0.002), retinal pigment clumps (p = 0.015) and SRNVM on OCT with bunching of capillaries in DCP and vessels in outer retina (p = 0.002). Five eyes showed conversion to group 2B at final visit. CONCLUSION There exists a distinct disease stage called "preproliferative" MacTel type 2 showing clinical features of non-proliferative disease, diffuse + focal perifoveal hyperfluoroscence on FA, absent SRNVM on OCT and bunching perifoveal capillaries in DCP on OCTA. Its identification is important for suspecting proliferative disease, planning management and follow-up visit accordingly.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India.
| | - Nikitha Gurram Reddy
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Pranjal Mishra
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Arpitha Pereira
- Stanley Eye Unit, Abergele Hospital, Llanfair Road, Abergele, Conwy, LL22 8DP, UK
| | - Deepashri Mutalik
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Sameeksha Agrawal
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Abhishek Bhatt
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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COMPARISON OF PROJECTION-RESOLVED OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY-BASED METRICS FOR THE EARLY DETECTION OF RETINAL MICROVASCULAR IMPAIRMENTS IN DIABETES MELLITUS. Retina 2021; 40:1783-1792. [PMID: 31584558 DOI: 10.1097/iae.0000000000002655] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine the ability of nonperfusion, vessel density, and morphologic measurements using projection-resolved optical coherence tomography angiography to detect early retinal microvasculature impairments in diabetes mellitus. METHODS A retrospective review was performed on Type 2 diabetes mellitus patients with no diabetic retinopathy (DR) or mild nonproliferative DR and age-matched controls imaged with optical coherence tomography angiography. Foveal avascular zone-related metrics and extrafoveal avascular area were measured in optical coherence tomography angiography images. Vessel density and fractal dimension were calculated with and without a skeletonization process. The vessel diameter index and vessel tortuosity were computed. The area under the receiver operating characteristic curve (AUC) estimated diagnostic performances. RESULTS Dilated capillary diameter was observed in the deep capillary plexus in the diabetic groups. Vessel density and fractal dimension of skeletonized deep capillary plexus significantly and progressively decreased in the no DR and mild nonproliferative DR groups compared with controls. Superficial extrafoveal avascular area, vessel density, and fractal dimension of the skeletonized deep capillary plexus had the highest diagnostic performance to differentiate mild nonproliferative DR from control eyes, with AUCs of 0.885, 0.876, and 0.876, respectively. CONCLUSION Vessel density and fractal dimension from the skeletonized deep capillary network may be the most sensitive for detecting early retinal capillary loss in diabetes mellitus.
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16
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CHOROIDAL NEOVASCULAR AREA AND VESSEL DENSITY COMPARISON BETWEEN TWO SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY DEVICES. Retina 2021; 40:521-528. [PMID: 30589664 DOI: 10.1097/iae.0000000000002430] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare choroidal neovascularization (CNV) area and vessel density (VD) measurements between two different swept-source optical coherence tomography angiography (SS-OCTA) devices. METHODS En face optical coherence tomography angiography (OCTA) images of patients affected by neovascular age-related macular degeneration were collected prospectively from two devices: Zeiss PLEX Elite 9000 (Carl Zeiss Meditec, Dublin, CA) and Topcon DRI OCT Triton SS-OCTA (Topcon, Tokyo, Japan). Choroidal neovascularization area and VD of images were measured and analyzed with ImageJ software by two readers to evaluate the agreement between two devices, with respect to different image size (3 × 3 and 6 × 6 mm) and different image segmentation (automatic vs. manual), and a Topcon equivalent Zeiss segmentation as control (i.e., the equivalent anatomical slab given by Topcon device on the Zeiss device). RESULTS A total of 30 eyes (30 patients) were analyzed. There was an excellent agreement between the two readers in CNV area measurements intraclass correlation coefficient >0.9 in all analyses. We found excellent agreement in CNV area measurements (manual and automatic segmentations) when comparing 3 × 3-mm or 6 × 6-mm images both for each single device and between the two devices (overall intraclass correlation coefficient > 0.9). Vessel density measurements between manual to automatic segmentation within the same device and same image size had a high intraclass correlation coefficient value, but there was a poor agreement in VD between different image sizes (3 × 3 mm vs. 6 × 6 mm) in the same device and also comparing the two devices (3 × 3 Topcon vs. 3 × 3 Zeiss; 6 × 6 Topcon vs. 6 × 6 Zeiss). There was a poor agreement between the Topcon equivalent Zeiss segmentation and all other segmentations. CONCLUSION There was an excellent agreement in CNV area measurements for both swept-source optical coherence tomography angiography devices in automatic and manual segmentations. However, the Topcon equivalent Zeiss segmentation was not comparable with any of the preset segmentations of Topcon and Zeiss devices. There was a poor agreement in CNV VD between different image size and different devices. For these reasons, it seems that, for accurate longitudinal analysis of VD, it is better to use the same device for each individual, even if both devices can be used interchangeably for CNV area measurements using automatic or manual segmentations.
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Hormel TT, Huang D, Jia Y. Artifacts and artifact removal in optical coherence tomographic angiography. Quant Imaging Med Surg 2021; 11:1120-1133. [PMID: 33654681 PMCID: PMC7829161 DOI: 10.21037/qims-20-730] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Abstract
Optical coherence tomographic angiography (OCTA) enables rapid imaging of retinal vasculature in three dimensions. While the technique has provided quantification of healthy vessels as well as pathology in several diseases, it is not unusual for OCTA data to contain artifacts that may influence measurement outcomes or defy image interpretation. In this review, we discuss the sources of several OCTA artifacts-including projection, motion, and signal reduction-as well as strategies for their removal. Artifact compensation can improve the accuracy of OCTA measurements, and the most effective use of the technology will incorporate hardware and software that can perform such correction.
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Affiliation(s)
- Tristan T. Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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18
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Changes in retinal microvasculature and retinal layer thickness in association with apolipoprotein E genotype in Alzheimer's disease. Sci Rep 2021; 11:1847. [PMID: 33469106 PMCID: PMC7815838 DOI: 10.1038/s41598-020-80892-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022] Open
Abstract
Biomarker tests of Alzheimer’s disease (AD) are invasive and expensive. Recent developments in optical coherence tomography (OCT) and OCT angiography (OCTA) have enabled noninvasive, cost-effective characterization of retinal layer vasculature and thickness. Using OCTA and OCT, we characterized retinal microvascular changes in the mild cognitive impairment (MCI) stage of AD and assessed their correlation with structural changes in each retinal neuronal layer. We also evaluated the effect of the APOE-ε4 genotype on retinal microvasculature and layer thickness. Retinal layer thickness did not differ between MCI patients (40 eyes) and controls (37 eyes, all p > 0.05). MCI patients had lower vessel density (VD) (p = 0.003) of the superficial capillary plexus (SCP) and larger foveal avascular zone area (p = 0.01) of the deep capillary plexus (DCP) than those of controls. VD of the SCP correlated with the ganglion cell layer (r = 0.358, p = 0.03) and inner plexiform layer thickness (r = 0.437, p = 0.007) in MCI patients. APOE-ε4-carrying MCI patients had a lower VD of the DCP than non-carriers (p = 0.03). In conclusion, retinal microvasculature was reduced in patients with AD-associated MCI, but retinal thickness was not changed; these changes might be affected by the APOE genotype. OCTA of the retinal microvasculature may be useful to detect vascular changes in AD.
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19
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Hormel TT, Jia Y, Jian Y, Hwang TS, Bailey ST, Pennesi ME, Wilson DJ, Morrison JC, Huang D. Plexus-specific retinal vascular anatomy and pathologies as seen by projection-resolved optical coherence tomographic angiography. Prog Retin Eye Res 2021; 80:100878. [PMID: 32712135 PMCID: PMC7855241 DOI: 10.1016/j.preteyeres.2020.100878] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
Optical coherence tomographic angiography (OCTA) is a novel technology capable of imaging retinal vasculature three-dimensionally at capillary scale without the need to inject any extrinsic dye contrast. However, projection artifacts cause superficial retinal vascular patterns to be duplicated in deeper layers, thus interfering with the clean visualization of some retinal plexuses and vascular pathologies. Projection-resolved OCTA (PR-OCTA) uses post-processing algorithms to reduce projection artifacts. With PR-OCTA, it is now possible to resolve up to 4 distinct retinal vascular plexuses in the living human eye. The technology also allows us to detect and distinguish between various retinal and optic nerve diseases. For example, optic nerve diseases such as glaucoma primarily reduces the capillary density in the superficial vascular complex, which comprises the nerve fiber layer plexus and the ganglion cell layer plexus. Outer retinal diseases such as retinitis pigmentosa primarily reduce the capillary density in the deep vascular complex, which comprises the intermediate capillary plexus and the deep capillary plexus. Retinal vascular diseases such as diabetic retinopathy and vein occlusion affect all plexuses, but with different patterns of capillary loss and vascular malformations. PR-OCTA is also useful in distinguishing various types of choroidal neovascularization and monitoring their response to anti-angiogenic medications. In retinal angiomatous proliferation and macular telangiectasia type 2, PR-OCTA can trace the pathologic vascular extension into deeper layers as the disease progress through stages. Plexus-specific visualization and measurement of retinal vascular changes are improving our ability to diagnose, stage, monitor, and assess treatment response in a wide variety of optic nerve and retinal diseases. These applications will be further enhanced with the continuing improvement of the speed and resolution of the OCT platforms, as well as the development of software algorithms to reduce artifacts, improve image quality, and make quantitative measurements.
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Affiliation(s)
- Tristan T Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yifan Jian
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Mark E Pennesi
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - John C Morrison
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA.
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20
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Mehta N, Braun PX, Gendelman I, Alibhai AY, Arya M, Duker JS, Waheed NK. Repeatability of binarization thresholding methods for optical coherence tomography angiography image quantification. Sci Rep 2020; 10:15368. [PMID: 32958813 PMCID: PMC7505834 DOI: 10.1038/s41598-020-72358-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Binarization is a critical step in analysis of retinal optical coherence tomography angiography (OCTA) images, but the repeatability of metrics produced from various binarization methods has not been fully assessed. This study set out to examine the repeatability of OCTA quantification metrics produced using different binarization thresholding methods, all of which have been applied in previous studies, across multiple devices and plexuses. Successive 3 × 3 mm foveal OCTA images of 13 healthy eyes were obtained on three different devices. For each image, contrast adjustments, 3 image processing techniques (linear registration, histogram normalization, and contrast-limited adaptive histogram equalization), and 11 binarization thresholding methods were independently applied. Vessel area density (VAD) and vessel length were calculated for retinal vascular images. Choriocapillaris (CC) images were quantified for VAD and flow deficit metrics. Repeatability, measured using the intra-class correlation coefficient, was inconsistent and generally not high (ICC < 0.8) across binarization thresholds, devices, and plexuses. In retinal vascular images, local thresholds tended to incorrectly binarize the foveal avascular zone as white (i.e., wrongly indicating flow). No image processing technique analyzed consistently resulted in highly repeatable metrics. Across contrast changes, retinal vascular images showed the lowest repeatability and CC images showed the highest.
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Affiliation(s)
- Nihaal Mehta
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Department of Ophthalmology, University of Colorado, Denver, CO, USA
| | - Phillip X Braun
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Isaac Gendelman
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - A Yasin Alibhai
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Malvika Arya
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Jay S Duker
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Nadia K Waheed
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
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21
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22
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Corvi F, Sadda SR, Staurenghi G, Pellegrini M. Thresholding strategies to measure vessel density by optical coherence tomography angiography. Can J Ophthalmol 2020; 55:317-322. [PMID: 32439196 DOI: 10.1016/j.jcjo.2020.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A variety of binarization strategies have been used to measure vessel density by optical coherence tomography angiography (OCT-A), but it is uncertain if they produce similar results. The purpose of the study was to evaluate the impact of different thresholding methods and contrast and brightness adjustment on OCT-A vessel density metrics. DESIGN Observational, cross-sectional case series. PARTICIPANTS Consecutive healthy volunteers. METHODS Healthy volunteers underwent fovea-centred 3 mm × 3 mm OCT-A scans using PlexElite 9000. Images of the superficial vascular plexus were generated using the instrument's automated segmentation. Images were thresholded with 5 different threshold tools in ImageJ (Default, Huang, IsoDat, Mean, and Otsu), and the threshold grey level value defined by each method was recorded. Brightness and contrast were also increased or decreased by 50% compared with the default. Binarization was performed using the threshold values from each method, and vessel densities were computed and compared. MAIN OUTCOME MEASURES Superficial plexus vessel density was measured and compared using different adjust threshold tools and changing brightness and contrast. RESULTS Twenty eyes of 20 healthy participants were included. Different threshold strategies produced measurements with different mean values (p < 0.0001). Pairwise comparisons revealed differences between all groups (p < 0.0001) except between the IsoData and Otsu thresholding approaches (p > 0.270). Increasing or decreasing the brightness or to 50% of the mean value also yielded statistically significant differences (p < 0.0001). CONCLUSIONS The method of thresholding and adjustments in contrast and brightness can significantly impact retinal vessel density measurements. These findings highlight the importance of using consistent thresholding strategies for clinical studies.
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Affiliation(s)
- Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - Marco Pellegrini
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
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23
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Park YG, Park YH. Quantitative analysis of retinal microvascular changes in macular telangiectasia type 2 using optical coherence tomography angiography. PLoS One 2020; 15:e0232255. [PMID: 32348375 PMCID: PMC7190136 DOI: 10.1371/journal.pone.0232255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/10/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate retinal vascular changes on optical coherence tomography angiography (OCTA) in patients with macular telangiectasia type 2 (MacTel 2) and to assess their correlation with visual acuity. METHODS Twenty-six patients (52 eyes) with MacTel 2 and 20 age-matched controls (40 eyes) were included. Fundus examinations, including fundus autofluorescence, swept-source optical coherence tomography, and OCTA, were performed. Differences in the vascular density in the fovea and parafovea, the area of the foveal avascular zone, and the diameter of the ellipsoid zone defect of the two groups were analyzed. RESULTS The foveal vascular density of the superficial capillary plexus was significantly lower in the MacTel 2 group than in the control group (p = 0.027). The vascular density in the entire deep capillary plexus was also significantly less in the MacTel 2 group than in the control group (all p < 0.05). The mean diameter of ellipsoid-zone disruption on OCT in the MacTel 2 group was 634.6 ± 104.3 𝜇m. The foveal avascular zone areas of the superficial and deep capillary plexuses were significantly enlarged in the MacTel 2 group compared to those in the control group (0.45 ± 0.12 mm2 vs. 0.27 ± 0.08 mm2, p < 0.001; 0.56 ± 0.15 mm2 vs. 0.40 ± 0.14 mm2, p = 0.001). In addition, the enlarged foveal avascular zone of the superficial and deep plexus was negatively correlated with best corrected visual acuity (logMAR) in MacTel 2 patients (p = 0.013, r = -0.642 and p = 0.042, and r = -0.511, respectively). CONCLUSIONS Retinal vascular density changes occur in the superficial fovea and in the entire deep capillary plexus of patients with MacTel 2. The enlarged foveal avascular zone areas of the superficial and deep plexuses were prominent in the MacTel 2 group, and this enlargement correlates with worsened visual acuity.
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Affiliation(s)
- Young Gun Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Hoon Park
- Catholic Institute for Visual Science, Collage of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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Mikhail M, Jiang S, Hahn P, Orlin A, Rao RC, Choudhry N. OCTA: A Practical Method of Image Averaging Using Adobe Photoshop Software. Ophthalmic Surg Lasers Imaging Retina 2020; 50:802-807. [PMID: 31877227 DOI: 10.3928/23258160-20191119-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE To describe a method for averaging ocular coherence tomography angiography (OCTA) images using a commercially available photo editing software: Adobe Photoshop CC 2017. PATIENTS AND METHODS This single-center study assessed the feasibility of using Adobe Photoshop as an OCTA image averaging tool. Three 3.0 mm × 3.0 mm OCTA images from each eye were obtained using commercially available OCTA devices. Captured OCTA images were exported in high-resolution TIFF format, imported as an image stack, aligned using an automated function, and averaged by creating a Smart Object using Photoshop CC 2017 software. In conjunction with qualitative assessment, the main outcome of the study was image grader preferences with respect to clarity of the foveal avascular zone (FAZ), blood vessel delineation, and the ability to identify abnormal vasculature. RESULTS After removing OCTA scans with significant image distortion, 25 sets of images were included in the analysis. Adobe Photoshop CC 2017 successfully aligned and averaged all images of the superficial and deep retinal plexuses that contained a minimum 40% overlap. Three independent retinal specialists found the averaged images to be slightly or definitely preferable to the original 87%, 89%, and 69% of the time with respect to clarity of the FAZ, clarity of blood vessel delineation, and the ability to identify abnormal vasculature, respectively. CONCLUSIONS Adobe Photoshop CC 2017 is an excellent tool for image averaging, producing high-quality resulting OCTA images. As an easily accessible software, Photoshop has the potential for use in a diversity of pathological conditions. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:802-807.].
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Micevych PS, Soetikno BT, Fawzi AA. Perivenular Capillary Loss: An Early, Quantifiable Change in Macular Telangiectasia Type 2. Transl Vis Sci Technol 2020; 9:5. [PMID: 32818093 PMCID: PMC7396175 DOI: 10.1167/tvst.9.4.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/08/2019] [Indexed: 01/18/2023] Open
Abstract
Purpose To evaluate differences in parafoveal vascular density surrounding arterioles and venules in type 2 macular telangiectasia (MacTel). Methods Thirty-seven eyes (20 subjects) diagnosed with MacTel and 16 healthy eyes (10 subjects) were imaged with optical coherence tomography angiography between March 2016 and June 2019 in this single-center, observational, cross-sectional study. Arterioles and venules were manually identified, and perivascular density was generated using a custom MATLAB code. The primary outcome measure was the ratio of periarteriolar to perivenular vascular density (arteriovenous [A/V] capillary ratio) in the superficial and deep capillary plexuses across MacTel stages. The main secondary outcome measures were overall parafoveal vascular density (VD), periarteriolar VD, and perivenular VD. Results In the superficial capillary plexus (SCP), the A/V capillary ratio was significantly higher in MacTel subjects than controls (0.914 vs. 0.892; P = 0.0044). The greatest differences occurred between controls and nonproliferative MacTel subjects without optical coherence tomography evidence of disease (P = 0.0055). A/V capillary ratios progressed in a nonlinear fashion with MacTel severity, increasing from nonproliferative disease (0.912) to intraretinal proliferative disease (0.931), then decreasing in subretinal proliferative disease (0.905). Parafoveal VD in the SCP was lower in MacTel subjects than controls only in subretinal proliferative disease (P = 0.0130). Conclusions The A/V capillary ratio of the SCP is a quantifiable metric of vascular pathology in MacTel that occurs earlier than decline in parafoveal VD. Elevated A/V capillary ratios in MacTel are consistent with an early, disproportionately perivenular disruption in the SCP. Translational Relevance Findings inform MacTel pathogenesis through revealing early perivenular capillary loss and offer a new quantitative metric for earliest stage MacTel.
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Affiliation(s)
- Paul S Micevych
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian T Soetikno
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Estawro RG, Embabi SN. Optical Coherence Tomography Angiography in Monitoring Proliferative Macular Telangiectasia Type 2 Treatment Response. Ophthalmic Surg Lasers Imaging Retina 2020; 50:485-491. [PMID: 31415694 DOI: 10.3928/23258160-20190806-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/17/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Difficulty exists in the follow-up of proliferative macular telangiectasia type 2 (MacTel 2) cases after anti-vascular endothelial growth factor (VEGF) treatment due to staining in fluorescein angiography (FA) and alteration in retinal layers by optical coherence tomography (OCT). Herein, the authors report three cases in which OCT angiography (OCTA) could resolve this issue. PATIENTS AND METHODS In this retrospective, observational case series, diagnosis of MacTel 2 was made based on clinical examination, FA, OCT, and OCTA at presentation. Regression of neovessels was monitored by OCT and OCTA. RESULTS OCTA could delineate neovessels before treatment in all cases and facilitate differentiation between active and regressed lesions after treatment. Simultaneous OCT images were less easily appreciated due to altered retinal structure secondary to degenerative nature of the disease. CONCLUSION OCTA could be the tool of choice to monitor neovascular response to anti-VEGF treatment in proliferative MacTel 2. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:485-491.].
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Pierro L, Iuliano L, Gagliardi M, Arrigo A, Bandello F. Higher Vascular Density of the Superficial Retinal Capillary Plexus in Degenerative Lamellar Macular Holes. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e112-e117. [PMID: 30998254 DOI: 10.3928/23258160-20190401-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/04/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Optical coherence tomography angiography (OCTA) comparison between vessel density in patients with degenerative-subtype lamellar macular hole (LMH) and healthy individuals. Unaffected fellow eyes were also included in the study. PATIENTS AND METHODS This observational, cross-sectional study examined 32 eyes affected by unilateral degenerative-subtype LMH, as well as the 32 fellow eyes of the enrolled population. Thirty healthy eyes were used as controls. ImageJ software was used to calculate macular vessel density in the three vascular plexuses (superficial capillary plexus [SCP], deep capillary plexus [DCP], choriocapillaris [CC]) in two regions: (1) a fovea-centered 1.5-mm diameter circular area after subtracting the foveal avascular zone (FAZ) area, obtaining a "ring" in the immediate FAZ proximity (peri-FAZ); (2) the area external to (1) included in the scan. RESULTS In the peri-FAZ, the SCP of both LMH and fellow eyes showed higher vascular density than in controls (P = .004 for LMH; P = .015 for fellow eye), whereas no difference was evident between LMH and fellow eyes (P = .190). No changes were found in the DCP or the CC. No differences in vessel density of the three plexuses in the area outside the peri-FAZ were evident in any of the three groups. The FAZ in the SCP was larger in the LMH (0.39 ± 0.16 mm2) and in the fellow eye (0.39 ± 0.21 mm2) groups compared with controls (0.27 ± 0.07 mm2; P = .021 for LMH; P = .0043 for fellow eye), whereas it was similar between LMH and fellow eyes (P = .967). CONCLUSIONS Degenerative-subtype LMH in the immediate proximity of the FAZ has a larger FAZ and higher vascular density in the SCP compared with healthy eyes. Unaffected fellow eyes also have increased vascular density compared with controls. Microvascular changes are evident in both LMH and unaffected fellow eyes and might play a role in disease pathogenesis. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e112-e117.].
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Inanc M, Tekin K, Kiziltoprak H, Ozalkak S, Doguizi S, Aycan Z. Changes in Retinal Microcirculation Precede the Clinical Onset of Diabetic Retinopathy in Children With Type 1 Diabetes Mellitus. Am J Ophthalmol 2019; 207:37-44. [PMID: 31009594 DOI: 10.1016/j.ajo.2019.04.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/30/2019] [Accepted: 04/13/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate whether abnormal glucose metabolism in diabetes mellitus (DM) affects the retinal microcirculation of children with well-controlled type 1 DM and to compare these results with those obtained from healthy children. DESIGN Cross-sectional prospective study. METHODS This study enrolled 60 patients with DM without clinically detectable diabetic retinopathy (DR) and 57 age-matched control subjects. Optical coherence tomography angiography (OCT-A) was performed using AngioVue (Avanti, Optivue). Foveal avascular zone (FAZ) area, nonflow area, superficial and deep vessel densities, FAZ perimeter, acircularity index of FAZ (AI; the ratio of the perimeter of FAZ and the perimeter of a circle with equal area), and foveal density (FD-300; vessel density in 300 μm around FAZ) were analyzed. Correlations between the investigated OCT-A parameters with DM duration and glycated hemoglobin (HbA1c) levels were evaluated among patients with type 1 DM. RESULTS Differences in the mean values for FAZ perimeter, AI, and FD-300 were statistically significant between DM group and control group (P < .001, P = .001, and P = .009, respectively). There were also statistically significant differences between the groups for vessel densities of deep superior hemi-parafovea, deep temporal parafovea, and deep superior parafoveal zones (P = .008, P = .015, and P = .005, respectively). There were no significant correlations between DM duration and HbA1c levels with the investigated OCT-A parameters. CONCLUSION Diabetic eyes without clinically detectable DR exhibited alterations in FD-300, AI, perimeter, and vessel density of parafoveal capillaries in deep capillary plexus preceding the enlargement of FAZ; therefore, these new parameters might be sensitive imaging biomarkers to define early DR.
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Overlap between telangiectasia and photoreceptor loss increases with progression of macular telangiectasia type 2. PLoS One 2019; 14:e0224393. [PMID: 31658282 PMCID: PMC6816569 DOI: 10.1371/journal.pone.0224393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To examine the topographical correlation between ellipsoid zone loss and telangiectasia in the deep capillary plexus in patients with macular telangiectasia type 2 (MacTel). METHODS 38 eyes (20 subjects) diagnosed with MacTel were imaged with OCTA between March 2016 and June 2019 in this single center, cross-sectional observational study. The en face OCTA and OCT were evaluated for areas of deep capillary plexus telangiectasia and ellipsoid zone loss, respectively, and their outlines were superimposed to study their overlap (mm2). The primary outcome was percentage of overlap and its relationship to MacTel stage. Secondary outcomes included the relationship between neovascularization and hyperreflective foci as well as correlations between ellipsoid zone loss, deep capillary plexus telangiectasia and visual acuity. RESULTS In nonproliferative MacTel stage, ellipsoid zone loss was localized to margins of telangiectatic areas (mean overlap = 15.2%). In proliferative stages, ellipsoid zone loss showed a higher degree of overlap with telangiectatic areas (mean overlap = 62.8%). Overlap increased with advancing MacTel stages, with an overall average of 45.3%. Overlap correlated highly with ellipsoid zone loss (r = 0.831; p<0.0001). Telangiectasia was present in all 38 eyes (range: 0.08mm2-0.99mm2), while ellipsoid zone loss was absent in 6 (range: 0.00-3.32mm2). Visual acuity correlated most strongly with ellipsoid zone loss (r = 0.569; p = 0.0002), followed by overlap (r = 0.544; p = 0.0004), and finally, telangiectasia (r = 0.404; p<0.0118). Presence of hyperreflective foci on OCT correlated with the presence and intraretinal location of neovascularization. CONCLUSIONS Ellipsoid zone loss occurs at the margins of deep capillary plexus telangiectasia in nonproliferative MacTel, with progressively increasing overlap as MacTel advances, peaking in proliferative disease. Deep capillary plexus telangiectasia and its overlap with ellipsoid zone loss are two promising markers of nonproliferative MacTel, while hyper-reflective foci are markers for proliferative MacTel.
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Demir ST, Güven D, Karatas ME, Dirim AB, Sendül SY, Ustaoglu M. Evaluation of 1-year follow-up results of macular telangiectasia type 2 cases by optical coherence tomography angiography. GMS OPHTHALMOLOGY CASES 2019; 9:Doc29. [PMID: 31531275 PMCID: PMC6734514 DOI: 10.3205/oc000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The results of 1-year follow-up with optical coherence tomography angiography (OCTA) of 3 patients with macular telangiectasia type 2 (MacTel 2) were evaluated. The 3X3 mm OCTA imaging was performed in January 2017 and February 2018. The superficial and deep capillary plexus vascular density changes of the whole area, the parafoveal temporal and parafoveal nasal areas were examined. The mean whole, parafoveal temporal, and parafoveal nasal vessel densities at superficial capillary plexus were 51.31, 50.39, 54.57 at baseline and 49.93, 46.79, 51.83 at 1-year follow-up, respectively. The mean whole, parafoveal temporal and parafoveal nasal vessel densities at deep capillary plexus were 59.06, 59.05, 63.39 at baseline and 52.18, 54.68, 57.9 at 1-year follow-up, respectively. In this case series, it was shown quantitatively that vessel densities of MacTel2 patients markedly decreased over time, more pronounced in the deep capillary plexus.
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Affiliation(s)
- Semra Tiryaki Demir
- Department of Ophthalmology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Dilek Güven
- Department of Ophthalmology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Egemen Karatas
- Department of Ophthalmology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ayse Burcu Dirim
- Department of Ophthalmology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Selam Yekta Sendül
- Department of Ophthalmology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Melih Ustaoglu
- Department of Ophthalmology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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Mehta N, Liu K, Alibhai AY, Gendelman I, Braun PX, Ishibazawa A, Sorour O, Duker JS, Waheed NK. Impact of Binarization Thresholding and Brightness/Contrast Adjustment Methodology on Optical Coherence Tomography Angiography Image Quantification. Am J Ophthalmol 2019; 205:54-65. [PMID: 30885708 DOI: 10.1016/j.ajo.2019.03.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Binarization is a critical technique in optical coherence tomography angiography (OCTA) image analysis, but there is no consistency in the method used in published OCTA studies. This study assessed whether differences in OCTA binarization and brightness and contrast adjustments affect quantification measurements. DESIGN Prospective cross-sectional validity study. METHODS This was a single-center study examining 21 eyes of 11 healthy individuals. All eyes were imaged using a swept-source OCTA (Zeiss), and quantitative measurements resulting from five binarization thresholding and five brightness/contrast adjustment methods were compared. All measurements were calculated for the superficial plexus and choriocapillaris (CC), as well as unaveraged and averaged en face OCTA images. RESULTS There were statistically significant differences between measurements from different binarization thresholding methods (P < 0.0001), as well as measurements from different histogram adjustments (P < 0.0001). The binarization thresholds yielded different measurements when combined with variable brightness/contrast adjustments. The method of analysis also affected the directionality of trends in imaging measurements between unaveraged and averaged CC images. CONCLUSIONS The method of OCTA image binarization thresholding and histogram adjustment significantly alters quantitative measurements and the directionality of trends. Results obtained from different OCTA binarization methods should be seen as valid only for that given method. This has significant consequences for clinical trials using OCTA measurements as outcome measurements. A consensus is needed across the research community for a consistent method for OCTA image quantification and greater attention paid to fully describing methods in published studies.
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Tzaridis S, Wintergerst MWM, Mai C, Heeren TFC, Holz FG, Charbel Issa P, Herrmann P. Quantification of Retinal and Choriocapillaris Perfusion in Different Stages of Macular Telangiectasia Type 2. ACTA ACUST UNITED AC 2019; 60:3556-3562. [DOI: 10.1167/iovs.19-27055] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Simone Tzaridis
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Clarissa Mai
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Tjebo F. C. Heeren
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- University College London, Institute of Ophthalmology, London, United Kingdom
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, and Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Abstract
BACKGROUND The foveal avascular zone (FAZ) has often been analyzed under different aspects in the last decades, mainly by fluorescence angiography (FA); however, the novel technology of optical coherence tomography angiography (OCTA) enables a non-invasive examination, visualization and quantitative analysis of the FAZ, which has recently led to many new findings, especially in a multidisciplinary manner. This article provides an overview of the investigation of the FAZ using OCTA and the new findings that have been obtained using OCTA in recent years. METHODS This article is based on a comprehensive literature review. RESULTS In many studies a good reproducibility and repeatability of the FAZ measurements by OCTA could be proven, also by comparing different OCTA devices. In patients with ocular pathologies and systemic diseases, e. g. after retinal vein occlusion or retinal surgery and in patients with diabetes mellitus without diabetic retinopathy, differences to healthy control groups and correlations to visual function could be shown. Moreover, in patients with neurological diseases, such as Alzheimer's dementia, changes of the FAZ could be identified. CONCLUSION The OCTA is a non-invasive technology, which enables a reliable visualization and reproducible quantification of the FAZ. The size of the FAZ seems to be altered in different retinal and systemic diseases, which also may correlate with visual function; however, long-term studies evaluating the diagnostic value of these changes in the course of the disease are currently lacking.
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Epiretinal Neovascularization. ACTA ACUST UNITED AC 2019; 3:516-522. [DOI: 10.1016/j.oret.2019.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/12/2019] [Accepted: 01/29/2019] [Indexed: 11/15/2022]
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Pierro L, Iuliano L, Marchese A, Arrigo A, Rabiolo A, Bandello F. Reduced vascular perfusion density in idiopathic epiretinal membrane compared to macular pseudohole. Int Ophthalmol 2019; 39:2749-2755. [DOI: 10.1007/s10792-019-01119-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
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Wang JC, Miller JB. Optical Coherence Tomography Angiography: Review of Current Technical Aspects and Applications in Chorioretinal Disease. Semin Ophthalmol 2019; 34:211-217. [PMID: 31131663 DOI: 10.1080/08820538.2019.1620797] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Optical coherence tomography angiography (OCT-A) has enabled fast, non-invasive, high-resolution visualization of vasculature within the eye. In the past few years, it has become increasingly utilized for a range of disorders including age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, and uveitis among others. This article reviews technical aspects of OCT-A, its applications in chorioretinal disease, and known limitations of the technology.
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Affiliation(s)
- Jay C Wang
- a Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - John B Miller
- a Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
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Iuliano L, Fogliato G, Colombo R, Sacconi R, Querques G, Bandello F, Codenotti M. Reduced perfusion density of superficial retinal capillary plexus after intravitreal ocriplasmin injection for idiopathic vitreomacular traction. BMC Ophthalmol 2019; 19:108. [PMID: 31077176 PMCID: PMC6511184 DOI: 10.1186/s12886-019-1119-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 05/02/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To investigate, using optical coherence tomography angiography (OCT-A), changes in perfusion density and in the foveal avascular zone (FAZ) in eyes with idiopathic vitreomacular traction (VMT) after ocriplasmin injection. METHODS In this pilot study, we enrolled sixteen VMT eyes treated with intravitreal ocriplasmin injection. Sixteen healthy eyes were considered as controls. Macular perfusion density in 3 plexuses [superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC)] was calculated at baseline and at 1 month after injection. RESULTS After injection, VMT anatomically resolved in 9 eyes (56.2%), whereas 7 eyes (43.8%) achieved an incomplete VMT separation. Superficial capillary plexus perfusion density was reduced significantly after injection (from 0.427 ± 0.027 to 0.413 ± 0.028; p = 0.0146), while no differences were noted in the DCP (p = 0.2717) nor in the CC (p = 0.6848). Study-eye perfusion density was statistically similar to control eyes in all three plexuses, both at baseline and at follow-up. The FAZ in the SCP area remained unchanged after injection (p = 0.168) but was significantly inferior to controls both at baseline and at 1 month (0.198 ± 0.074 vs. 0.196 ± 0.070; p = 0.007). CONCLUSIONS Eyes with VMT have a perfusion density comparable to healthy controls, but a smaller FAZ. After ocriplasmin injection the perfusion density in the SCP is reduced, regardless the anatomical success. Limited by the small sample size and the pilot nature of the study, we found microvascular changes after ocriplasmin injection, which may be due to retinal traction release.
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Affiliation(s)
- Lorenzo Iuliano
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanni Fogliato
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Roberta Colombo
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Codenotti
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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Hypoxia tolerance in the Norrin-deficient retina and the chronically hypoxic brain studied at single-cell resolution. Proc Natl Acad Sci U S A 2019; 116:9103-9114. [PMID: 30988181 DOI: 10.1073/pnas.1821122116] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The mammalian CNS is capable of tolerating chronic hypoxia, but cell type-specific responses to this stress have not been systematically characterized. In the Norrin KO (Ndp KO ) mouse, a model of familial exudative vitreoretinopathy (FEVR), developmental hypovascularization of the retina produces chronic hypoxia of inner nuclear-layer (INL) neurons and Muller glia. We used single-cell RNA sequencing, untargeted metabolomics, and metabolite labeling from 13C-glucose to compare WT and Ndp KO retinas. In Ndp KO retinas, we observe gene expression responses consistent with hypoxia in Muller glia and retinal neurons, and we find a metabolic shift that combines reduced flux through the TCA cycle with increased synthesis of serine, glycine, and glutathione. We also used single-cell RNA sequencing to compare the responses of individual cell types in Ndp KO retinas with those in the hypoxic cerebral cortex of mice that were housed for 1 week in a reduced oxygen environment (7.5% oxygen). In the hypoxic cerebral cortex, glial transcriptome responses most closely resemble the response of Muller glia in the Ndp KO retina. In both retina and brain, vascular endothelial cells activate a previously dormant tip cell gene expression program, which likely underlies the adaptive neoangiogenic response to chronic hypoxia. These analyses of retina and brain transcriptomes at single-cell resolution reveal both shared and cell type-specific changes in gene expression in response to chronic hypoxia, implying both shared and distinct cell type-specific physiologic responses.
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Tzaridis S, Heeren T, Mai C, Thiele S, Holz FG, Charbel Issa P, Herrmann P. Right-angled vessels in macular telangiectasia type 2. Br J Ophthalmol 2019; 105:1289-1296. [PMID: 30808615 PMCID: PMC8380913 DOI: 10.1136/bjophthalmol-2018-313364] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/14/2018] [Accepted: 02/05/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the role of right-angled vessels (RAVs) during disease progression in macular telangiectasia type 2 (MacTel). METHODS In this study, 100 eyes of 52 patients and 52 eyes of 26 age-related controls were examined using fundus photography, spectral-domain optical coherence tomography (SD-OCT), OCT angiography (OCT-A) and fundus fluorescein angiography (FFA). Two masked readers graded fundus photographs of patients' eyes into five disease stages according to Gass and Blodi, and evaluated all eyes for the presence of RAVs. If RAVs were present, their course and origin (arterial vs venous) was evaluated with OCT-A and FFA, respectively. Additionally, we looked for morphological correlates of these vessels on SD-OCT scans. Neovascular eyes were analysed for the presence of RAVs and for morphological changes on formation of neovascularisations (NVs). RESULTS In OCT-A, RAVs were already detectable in eyes with early stages (1 to 2), could be tracked from superficial to outer retinal layers and were shown to form anastomoses in the outer retina with disease progression. These vessels were of both arterial and venous origin as shown by early phase FFA. Dilated capillaries and RAVs in OCT-A corresponded to hyper-reflective alterations of the outer retina on SD-OCT scans. In 19/19 eyes, NVs were associated with the presence of RAVs, and RAVs were shown to directly connect to neovascular complexes and to undergo morphological changes upon NV formation. CONCLUSIONS The results emphasise the role of RAVs during disease progression from an early stage on and demonstrate their involvement in the development of secondary NVs in MacTel.
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Affiliation(s)
- Simone Tzaridis
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Tjebo Heeren
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Clarissa Mai
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Sarah Thiele
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, and Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Philipp Herrmann
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Retinal vascular density evaluated by optical coherence tomography angiography in macular telangiectasia type 2. Int Ophthalmol 2019; 39:2245-2256. [PMID: 30607862 DOI: 10.1007/s10792-018-01060-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the retinal and choroidal vascular changes through optical coherence tomography angiography (OCTA) in patients with macular telangiectasia type 2 (MacTel 2). METHODS Our study included 20 patients (40 eyes) with MacTel 2, and age-matched and sex-matched 18 subjects (36 eyes) in the control group. Fundus color photographs, fundus autofluorescence, fundus fluorescein angiography, spectral-domain optical coherence tomography and OCTA were performed. Foveal vascular density and parafoveal vascular density (PFVD), and foveal retinal thickness and parafoveal retinal thickness, choroidal thickness (CT) and retinal ganglion cell-inner plexiform layer (GCIPL) were compared between MacTel 2 patients and normal age-matched controls. RESULTS The retinal whole vascular density and PFVD of the deep plexus were significantly lower in patients with MacTel 2 than that of the control group (56.93% vs. 58.54%, p = 0.003; and 60.38% vs. 61.66%, p = 0.045). The foveal avascular zone (FAZ) of the deep plexus was significantly enlarged in patients with MacTel 2 than that of the control group (0.44 vs. 0.36, p = 0.009). There was a positive and statistically significant correlation between the FAZ of the superficial and deep plexus and CT in patients with MacTel 2. There was a positive and statistically significant correlation between retinal whole, parafoveal temporal quadrant vascular density of the superficial and deep plexus and GCIPL thickness in patients with MacTel 2. CONCLUSIONS Our study demonstrated that important retinal vascular density and FAZ changes in MacTel 2 occur in the deep capillary plexus of the retina.
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Wang JC, Laíns I, Oellers P, Kim IK, Miller JW, Miller JB. Choroidal thickness and vascular density in macular telangiectasia type 2 using enface swept-source optical coherence tomography. Br J Ophthalmol 2019; 103:1584-1589. [DOI: 10.1136/bjophthalmol-2018-313414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/05/2018] [Accepted: 12/14/2018] [Indexed: 11/03/2022]
Abstract
PurposeTo investigate the choroidal thickness (CT) and choroidal vascular densities (CVD) of patients with macular telangiectasia type 2 (MacTel2) and their association with other multimodal imaging features, using swept-source optical coherence tomography (SS-OCT).MethodsProspective, cross-sectional study. Consecutive patients with MacTel2 along with controls without any macular disease were included. Fundus photography, confocal blue reflectance, near-infrared reflectance, autofluorescence, fluorescein angiography, spectral domain OCT and SS-OCT were performed. Images were independently analysed by two graders, and CVD was calculated from binarised en face SS-OCT images. CT was obtained from the SS-OCT platform via built-in automated segmentation. Multilevel mixed-effects models were used for statistical analysis.ResultsThirty-nine eyes of 20 patients with MacTel2 and 29 eyes of 15 control patients were included. Average CT and perifoveal temporal CT did not differ significantly between eyes with MacTel2 and control eyes (p≥0.350), when accounting for confounding factors. Overall and temporal CVD also did not significantly differ between the two groups (p≥0.490).ConclusionCT and CVD did not significantly differ between MacTel2 and control eyes in this study using SS-OCT. Even though MacTel2 may include abnormalities involving the choroid, these are likely minor in comparison to the predominant retinal changes.
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Rabiolo A, Gelormini F, Sacconi R, Cicinelli MV, Triolo G, Bettin P, Nouri-Mahdavi K, Bandello F, Querques G. Comparison of methods to quantify macular and peripapillary vessel density in optical coherence tomography angiography. PLoS One 2018; 13:e0205773. [PMID: 30335815 PMCID: PMC6193681 DOI: 10.1371/journal.pone.0205773] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/27/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose To compare macular and peripapillary vessel density values calculated on optical coherence tomography angiography (OCT-A) images with different algorithms, elaborate conversion formula, and compare the ability to discriminate healthy from affected eyes. Methods Cross-sectional study of healthy subjects, patients with diabetic retinopathy, and glaucoma patients (44 eyes in each group). Vessel density in the macular superficial capillary plexus (SCP), deep capillary plexus (DCP), and the peripapillary radial capillary plexus (RCP) were calculated with seven previously published algorithms. Systemic differences, diagnostic properties, reliability, and agreement of the methods were investigated. Results Healthy eyes exhibited higher vessel density values in all plexuses compared to diseased eyes regardless of the algorithm used (p<0.01). The estimated vessel densities were significantly different at all the plexuses (p<0.0001) as a function of method used. Inter-method reliability and agreement was mostly poor to moderate. A conversion formula was available for every method, except for the conversion between multilevel and fixed at the DCP. Substantial systemic, non-constant biases were evident between many algorithms. No algorithm outperformed the others for discrimination of patients from healthy subjects in all the retinal plexuses, but the best performing algorithm varied with the selected plexus. Conclusions Absolute vessel density values calculated with different algorithms are not directly interchangeable. Differences between healthy and affected eyes could be appreciated with all methods with different discriminatory abilities as a function of the plexus analyzed. Longitudinal monitoring of vessel density should be performed with the same algorithm. Studies adopting vessel density as an outcome measure should not rely on external normative databases.
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Affiliation(s)
- Alessandro Rabiolo
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Francesco Gelormini
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
- Eye Clinic, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - Giacinto Triolo
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
| | - Paolo Bettin
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
| | - Kouros Nouri-Mahdavi
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
- * E-mail:
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QUANTITATIVE ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN ADULT-ONSET FOVEOMACULAR VITELLIFORM DYSTROPHY. Retina 2018; 38:237-244. [PMID: 28145974 DOI: 10.1097/iae.0000000000001539] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To quantify the foveal avascular zone area at superficial capillary plexus (SCP) and deep capillary plexus (DCP) and the global, parafoveal, and perifoveal vessel densities at SCP, DCP, and choriocapillaris using optical coherence tomography angiography in patients affected by adult-onset foveomacular vitelliform dystrophy (AOFVD). METHODS Twenty eyes of 20 consecutive patients (10 females, 50%) with AOFVD and 20 eyes of 20 healthy controls presenting at the Department of Ophthalmology of San Raffaele Hospital, Milan, Italy were enrolled. All patients underwent a complete ophthalmic examination, including 3-mm × 3-mm optical coherence tomography angiography centered on the macula. The vessel density was calculated in the three plexuses (i.e., SCP, DCP, and choriocapillaris) by mean of image binarization, and foveal avascular zone area was manually outlined at SCP and DCP with ImageJ software. RESULTS In the SCP, patients with AOFVD disclosed a significant reduction of global (P < 0.001), parafoveal (P = 0.0017), and perifoveal (P = 0.0019) vessel density. In the DCP, parafoveal vessel density was higher in patients with AOFVD (P = 0.0026), whereas no significant difference was appreciated for both the global image (P = 0.5) and the perifoveal area (P = 0.5). Patients with AOFVD showed less dense choriocapillaris (P = 0.012) and perifoveal circle (P = 0.0152), whereas no difference was observed in the perifoveal zone (P = 0.07). Foveal avascular zone area was significantly enlarged at the DCP (P = 0.0184), but not at the SCP. CONCLUSION Patients with AOFVD have quantitative vascular alterations in all vascular layers.
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Cohen SY, Miere A, Nghiem-Buffet S, Fajnkuchen F, Souied EH, Mrejen S. Clinical applications of optical coherence tomography angiography: What we have learnt in the first 3 years. Eur J Ophthalmol 2018; 28:491-502. [PMID: 29554812 DOI: 10.1177/1120672117753704] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A review of the literature from 2014 to 2016 was conducted, focusing on the results of optical coherence tomography angiography in different chorioretinal diseases. In only 3 years, optical coherence tomography angiography has been shown to be an effective tool for diagnosing choroidal neovascularization complicating age-related macular degeneration, pathologic myopia, and inflammatory conditions. The technique has sometimes been considered superior to conventional multimodal imaging, for example, in choroidal neovascularization associated with chronic central serous chorioretinopathy or multifocal choroiditis. In retinal vascular diseases, optical coherence tomography angiography has helped to understand the condition described as paracentral acute middle maculopathy and has been considered highly effective for the analysis of retinal vascular macular changes secondary to retinal vein occlusion or macular telangiectasia. Changes in the foveal avascular zone, also reported in diabetic maculopathy, have been shown to occur before any angiographic signs. A reduction in capillary vascular density has been reported in the fovea of eyes with malignant melanoma, but not in eyes with choroidal nevus. However, optical coherence tomography angiography is a recent technique that probably needs refinements and further studies. Nevertheless, the first 3 years of optical coherence tomography angiography use suggest its clinical relevance and useful applications in daily clinical practice.
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Affiliation(s)
- Salomon Y Cohen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France.,2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Alexandra Miere
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | | | | | - Eric H Souied
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Sarah Mrejen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France
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Guo J, Tang W, Ye X, Wu H, Xu G, Liu W, Zhang Y. Predictive multi-imaging biomarkers relevant for visual acuity in idiopathic macular telangiectasis type 1. BMC Ophthalmol 2018; 18:69. [PMID: 29506510 PMCID: PMC5836363 DOI: 10.1186/s12886-018-0737-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/28/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To evaluate the structural changes associated with visual acuity (VA) in patients with idiopathic macular telangiectasia (MT) type 1 using multimodal imaging modalities. METHODS A retrospective study of 14 patients with MT type 1 and of 10 eyes from 10 healthy individuals as age-matched controls was conducted. The medical records of patients who had undergone colour fundus photography, spectral domain optical coherence tomography (OCT), fluorescein angiography and OCT angiography were reviewed. Central macular thickness (CMT), the areas of macular oedema and ellipsoid zone (EZ) disruption, EZ length, disorganization of the retinal inner layers (DRIL) and external limiting membrane (ELM) disruption, as measured by spectral domain OCT; and vascular density and the foveal avascular zones (FAZ) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), as measured by OCT angiography, were assessed in MT type 1 eyes and correlated with VA. RESULTS The mean baseline best-corrected VA of MT type 1 eyes was 0.45 ± 0.28. The mean CMT was 385.19 ± 75.21 μm in MT type 1 eyes and 252.43 ± 15.77 μm in contralateral eyes (Z = - 4.113, p < 0.001). The mean vessel density of the DCP was lower in MT type 1 eyes (47.25 ± 4.69%) than in contralateral eyes (53.93 ± 2.94%) and normal eyes (59.37 ± 2.50%) (Z = - 3.492, - 4.099; p < 0.001, < 0.001). The baseline logMAR VA was correlated with CMT (r = 0.682, p = 0.007), SCP density (r = - 0.652, p = 0.012), DCP density (r = - 0.700, p = 0.005), total area of EZ disruption (r = 0.649, p = 0.012); and total lengths of EZ (r = 0.681, p = 0.007), ELM (r = 0.699, p = 0.005) and DRIL (r = 0.707, p = 0.005) disruption in the 1-mm-diameter foveal region in MT type 1 eyes. CONCLUSIONS Decreased DCP density and the presence of DRIL may be predictive biomarkers of VA in MT type 1. CMT, SCP density, total area of EZ disruption, and lengths of EZ and ELM disruption within the 1-mm-diameter central region were strongly associated with VA.
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Affiliation(s)
- Jingli Guo
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - WenYi Tang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Xiaofeng Ye
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Haixiang Wu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Wei Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
| | - Yongjin Zhang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
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Sacconi R, Corbelli E, Carnevali A, Mercuri S, Rabiolo A, Querques L, Marchini G, Bandello F, Querques G. Optical coherence tomography angiography in pseudophakic cystoid macular oedema compared to diabetic macular oedema: qualitative and quantitative evaluation of retinal vasculature. Br J Ophthalmol 2018; 102:1684-1690. [PMID: 29463502 DOI: 10.1136/bjophthalmol-2017-311240] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/17/2018] [Accepted: 02/08/2018] [Indexed: 11/04/2022]
Abstract
AIMS To describe optical coherence tomography angiography (OCT-A) abnormalities of patients with pseudophakic cystoid macular oedema (PCMO) before and after pharmacological resolution, compared with diabetic macular oedema (DMO) and normal eyes. METHODS In this retrospective, observational study, 44 eyes (30 patients) were included: 15 eyes (15 patients) affected by PCMO; 14 healthy fellow eyes used as negative control group; 15 eyes (15 age-matched and sex-matched patients) with DMO used as positive control group. All patients underwent a complete ophthalmological examination at baseline, including OCT-A scans of the macula through AngioPlex CIRRUS-5000 (Carl Zeiss Meditec, Dublin, USA). Patients with PCMO and DMO were re-evaluated after the pharmacological resolution of cystoid macular oedema (CMO). RESULTS Disruption of parafoveal capillary arcade and cystoid spaces in deep capillary plexus (DCP) were frequent in patients with PCMO and DMO (73% and 100%, 87% and 100%). Capillary abnormalities and non-perfusion greyish areas in DCP were more frequent in DMO (P<0.001 and P=0.014). Patients with PCMO showed a larger foveal avascular zone area in DCP at baseline (P<0.001), which significantly reduced after treatment (P=0.001). Vessel density of full-thickness retina and DCP was reduced in patients with PCMO (P=0.022 and P=0.001), and no changes were observed after treatment. Interestingly, DCP appeared less represented in patients with DMO than PCMO subjects (P=0.001). CONCLUSIONS Patients with PCMO have an impairment of mainly DCP, partially reversible after treatment. Furthermore, we disclosed that different alterations of the retinal vasculature characterise CMO derived from two different diseases, namely PCMO and DMO, and this could be due to their distinct pathophysiology.
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Affiliation(s)
- Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Ophthalmology, University of Verona, University Hospital of Verona, Verona, Italy
| | - Eleonora Corbelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Adriano Carnevali
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Ophthalmology, University of 'Magna Graecia', Catanzaro, Italy
| | - Stefano Mercuri
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Rabiolo
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
- G.B. Bietti Foundation-IRCCS, Rome, Italy
| | - Giorgio Marchini
- Department of Ophthalmology, University of Verona, University Hospital of Verona, Verona, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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Tan ACS, Tan GS, Denniston AK, Keane PA, Ang M, Milea D, Chakravarthy U, Cheung CMG. An overview of the clinical applications of optical coherence tomography angiography. Eye (Lond) 2018; 32:262-286. [PMID: 28885606 PMCID: PMC5811700 DOI: 10.1038/eye.2017.181] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/15/2017] [Indexed: 12/15/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) has emerged as a novel, non-invasive imaging modality that allows the detailed study of flow within the vascular structures of the eye. Compared to conventional dye angiography, OCTA can produce more detailed, higher resolution images of the vasculature without the added risk of dye injection. In our review, we discuss the advantages and disadvantages of this new technology in comparison to conventional dye angiography. We provide an overview of the current OCTA technology available, compare the various commercial OCTA machines technical specifications and discuss some future software improvements. An approach to the interpretation of OCTA images by correlating images to other multimodal imaging with attention to identifying potential artefacts will be outlined and may be useful to ophthalmologists, particularly those who are currently still unfamiliar with this new technology. This review is based on a search of peer-reviewed published papers relevant to OCTA according to our current knowledge, up to January 2017, available on the PubMed database. Currently, many of the published studies have focused on OCTA imaging of the retina, in particular, the use of OCTA in the diagnosis and management of common retinal diseases such as age-related macular degeneration and retinal vascular diseases. In addition, we describe clinical applications for OCTA imaging in inflammatory diseases, optic nerve diseases and anterior segment diseases. This review is based on both the current literature and the clinical experience of our individual authors, with an emphasis on the clinical applications of this imaging technology.
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Affiliation(s)
- A C S Tan
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - G S Tan
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - A K Denniston
- Department of Ophthalmology, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - P A Keane
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - M Ang
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - D Milea
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - U Chakravarthy
- Department of Ophthalmology, Queen's University of Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
| | - C M G Cheung
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
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REPRODUCIBILITY OF VESSEL DENSITY MEASUREMENT WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN EYES WITH AND WITHOUT RETINOPATHY. Retina 2018; 37:1475-1482. [PMID: 27930458 DOI: 10.1097/iae.0000000000001407] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the intravisit and intervisit reproducibility of optical coherence tomography angiography measurements of macular vessel density in eyes with and without retinal diseases. METHODS Fifteen healthy volunteers and 22 patients with retinal diseases underwent repeated optical coherence tomography angiography (Angiovue Imaging System, Optovue Inc) scans after pupil dilation on 2 separate visit days. For each visit day, the eyes were scanned twice. Vessel density defined as the proportion of vessel area with flowing blood over the total measurement area was calculated using Angiovue software. Intravisit and intervisit reproducibility were summarized as coefficient of variations and intraclass correlation coefficients were calculated from variance component models. RESULTS The coefficient of variations representing the intravisit reproducibility of the superficial macular vessel density measurements for different quadrants on 3 mm × 3-mm scans varied from 2.1% to 4.9% and 3.4% to 6.8% for healthy and diseased eyes, respectively, and for the intervisit it was 2.9% to 5.1% and 4.0% to 6.8%, respectively. The coefficient of variations were lower in healthy eyes than in diseased eyes, lower for intravisit than for intervisit, lower on 3 mm × 3-mm scans than on 6 mm × 6-mm scans, and lower for paracentral subfields than for central subfield. CONCLUSION The evidence presented here demonstrates good reproducibility of optical coherence tomography angiography for measurement of superficial macula vessel density in both healthy eyes and eyes with diabetic retinopathy without diabetic macular edema.
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Patel RC, Wang J, Hwang TS, Zhang M, Gao SS, Pennesi ME, Bailey ST, Lujan BJ, Wang X, Wilson DJ, Huang D, Jia Y. Plexus-Specific Detection of Retinal Vascular Pathologic Conditions with Projection-Resolved OCT Angiography. Ophthalmol Retina 2018; 2:816-826. [PMID: 30148244 DOI: 10.1016/j.oret.2017.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective To evaluate the projection-resolved (PR) optical coherence tomography angiography (OCTA) algorithm in detecting plexus-specific vascular abnormalities in retinal pathologies. Design Cross-sectional observational clinical study. Participants Patients diagnosed with retinal vascular diseases and healthy volunteers. Methods Eyes were imaged using an OCT system operating at 840 nm and employing the split-spectrum amplitude decorrelation algorithm. A novel algorithm suppressed projection artifacts inherent to OCTA. The volumetric scans were segmented and visualized on different plexuses. Main Outcome Measures Qualitative observation of vascular abnormalities on both cross-sectional and en face PR-OCTA images. Results Eight illustrative cases are reported. In cases of diabetic retinopathy, retinal vessel occlusion, and retinitis pigmentosa, PR-OCTA detected retinal nonperfusion regions within deeper retinal plexuses not visualized by conventional OCTA. In age-related macular degeneration, cross-sectional PR-OCTA permitted the classification of choroidal neovascularization, and, in a case of retinal angiomatous proliferation, identified a vertical vessel contiguous with the deep capillary plexus. In macular telangiectasia, PR-OCTA detected a diving perifoveal vein and delineated subretinal neovascularization. Conclusions Application of PR-OCTA promises to improve sensitive, accurate evaluation of individual vascular plexuses in multiple retinal diseases.
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Affiliation(s)
- Rachel C Patel
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239.,University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655
| | - Jie Wang
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - Miao Zhang
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - Simon S Gao
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - Mark E Pennesi
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - Brandon J Lujan
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - Xiaogang Wang
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239.,Shanxi Eye Hospital, 100 Fudong St, Taiyuan, Shanxi, P.R. China, 030002
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
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