scholarly journals 949. Use of Optical Coherence Tomography Angiography to Assess Microvascular Health Among Persons with HIV: Employing the Retina as a Convenient Window

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S507-S507
Author(s):  
Lauren F Collins ◽  
Jessica G Shantha ◽  
Peter L Nesper ◽  
Anandi N Sheth ◽  
Amani A Fawzi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Optical Coherence Tomography Angiography ◽  
Retinal Vasculitis ◽  
Organ Damage ◽  
Screening Tools ◽  
Foveal Avascular Zone ◽  
Invasive Technique ◽  
Optical Coherence ◽  
Hiv Diagnosis ◽  
The Right

Abstract Background Mechanisms underlying the rising burden of non-AIDS comorbidities (NACM) among persons with HIV (PWH) remain unclear. Microvasculopathy may link HIV-related chronic inflammation and premature multimorbidity, similar to diabetes and other conditions characterized by inflammatory end-organ damage. We used a novel retinovascular imaging tool, optical coherence tomography angiography (OCTA), to evaluate the retina as a convenient assessment of microvascular health among PWH. Methods Data from 4 PWH who underwent OCTA (Zeiss CIRRUSTM HD-OCT 5000) at the Emory Eye Center from 2018-2020 were analyzed. Demographics, HIV-specific indices and NACM were summarized at the time of OCTA. Images were reviewed qualitatively and metrics of microvascular health – the foveal avascular zone (FAZ) area and vessel density (VD) from the superficial capillary plexus (SCP) – were calculated by ImageJ. Results The median age was 39 years, 100% were male, 100% were black, 25% had ever smoked, and median body mass index was 25.4 kg/m2. Median time since HIV diagnosis was 19 years, all patients had a history of clinical AIDS, including 2 with prior cytomegalovirus retinitis. Median current CD4 count was 84 cells/mm3, 100% were prescribed antiretroviral therapy and 50% had HIV viral suppression. Prevalent NACM included (each n=1): hypertension, dyslipidemia, diabetes, chronic kidney disease and asthma. Qualitatively, all 7 of the eyes evaluated by OCTA had evidence of microvascular pathology: 2 eyes demonstrated diffuse capillary nonperfusion, while the remaining 5 eyes had focal areas of nonperfusion around the FAZ. Mean FAZ area was 0.31 (SD±0.10) mm2 and mean VD of the SCP was 43.9% (SD±10.9%). Retinovascular pathology identified by fundoscopy and OCTA is shown in the figure. Figure. Retinal imaging of a PWH with bilateral retinal vasculitis. Fundus photos of the right (A) and left (C) eyes show retinal vasculitis highlighted by the red arrows. OCTA of the right (B) and left (D) maculae (3X3 scan Zeiss AngioplexTM) show the FAZ areas outlined in yellow, both of irregular contour. OCTA of the left macula demonstrates areas of significant flow voids marked by the asterisks and the FAZ area is enlarged. Conclusion Among patients with longstanding HIV, OCTA identified microvascular abnormalities in all retinae examined. Retinovascular evaluation by OCTA is a feasible, non-invasive technique for assessing microvascular health and findings support additional study in a larger, more diverse group of PWH. Screening tools targeting microvasculopathy among PWH may aid in earlier detection of those at greatest risk of NACM and allow for aggressive risk-modification strategies. Disclosures All Authors: No reported disclosures

Optical Coherence Tomography Angiography in idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome: A case report

2020 ◽  
pp. 112067212095759
Author(s):  
Meriem Ouederni ◽  
Hela Sassi ◽  
Zied Chelly ◽  
Fehmy Nefaa ◽  
Monia Cheour
Keyword(s):  
Optical Coherence Tomography ◽  
Optical Coherence Tomography Angiography ◽  
Retinal Vasculitis ◽  
Retinal Neovascularization ◽  
Optical Coherence ◽  
Fundus Fluorescein Angiography ◽  
Blurred Vision ◽  
Additional Tool ◽  
The Right

Purpose: Since its first description by Chang et al. in 1995, the diagnosis of Idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome has been based on the findings of Fundus Fluorescein Angiography (FFA). Our purpose was to describe the utility of optical coherence tomography angiography (OCT-A) in its diagnosis and management. Case description: A 40-year-old female presented with bilateral blurred vision. Her best corrected visual acuity was at 8/10. Fundus examination revealed blurred disc margins, perivascular exudates, arterial sheaths and retinal hemorrhages bilaterally. FFA showed staining of the optic disc with dye leakage in the right eye, a punctuate hyperfluorescence of the temporosuperior artery in the left eye, bilateral vascular sheathing and capillary dropout. OCT-A showed simultaneous presence of papillary aneurysm and neovascularization of the optic nerve head in the right eye, a papillary aneurysm in the left eye and bilateral capillary non-perfusion. Our patient was diagnosed with IRVAN syndrome. Oral steroids associated with panretinal laser photocoagulation and intravitreal injection of bevacizumab in the right eye resulted in vanishing of the papillary neovascularization with no recurrence on OCT-A at 10-month follow-up. Conclusions: OCT-A is an additional tool to FFA for visualization of arterial macroaneurysms and retinal neovascularization without the interference of dye leakage. It well demarcates nonperfused areas and ensures follow-up of retinal neovascularization. Its limitations are the limited field of view and the low sensitivity in detecting arteriolar dilations. Thus, OCT-A is unable to outplace FFA but should be considered alternately with it for non-invasive follow-up of IRVAN syndrome.

scholarly journals Foveal Avascular Zone in Hypertension as Measured by Optical Coherence Tomography Angiography

2019 ◽  
pp. 131-135
Author(s):  
Ludmila Gomes Dantas De Sá ◽  
Diego Nery Benevides Gadelha ◽  
Maria Cecília Santos Cavalcanti Melo ◽  
Carlos Teixeira Brandt
Keyword(s):  
Optical Coherence Tomography ◽  
Optical Coherence Tomography Angiography ◽  
Foveal Avascular Zone ◽  
Study Group ◽  
Optical Coherence ◽  
Control Groups ◽  
Hypertensive Patients ◽  
Avascular Zone ◽  
The Right ◽  
And Control

Purpose: To investigate the Foveal Avascular Zone (FAZ) area in patients with arterial hypertension using optical coherence tomography angiography (OCT-A).Material and methods: The study was permormed at the School Clinic of UNIFACISA and at the Eye Care Center. It was included 21 hypertensive patients (study group) and 19 individuals without hypertension (control group). It was excluded patientes with diabetes or glaucoma. The measurement of the FAZ areas was performed by the DRI OCT-1Triton/Plus. For the quantitative variables, the results were expressed by their means and standard deviations. Qualitative variables were expressed by their absolute and relative frequencies. Student’s t-test was used to verify differences between means and Fisher’s exact test for differences between frequencies. For evaluating the correlation between the superficial and deep plexus areas, the Pearson correlation test was used. P value ≤ 0.05, rejected the null hypothesis. The research was approved by the Ethics Committee of the Medical School from Campina Grande -UNIFACISA and all individuals signed the free and informed consent form.Results: The means of the superficial FAZ of both eyes was significantly higher in the study group (right eye 410.7 ± 160.7 μm2 - 319.1 ± 108.2 μm2 - p = 0.0433); (left eye: 405.4 ± 144.8 μm2 versus 309.4 ± 87.7 μm2- p = 0.0174). The means of the deep FAZ areas of the right and left eyes were similar between the study and control groups (right eye: 559.6 ± 253.28 μm2 versus 605.1 ± 226.8 μm2 - p = 0.5548); (left eye: 673.2 ± 170.8 μm2 versus 585.6 ± 171.2 μm2 - p = 0.1142). The relationships between the superficial and deep plexus areas of both eyes showed a weak correlation between the two plexuses. (r = 0.4734), left eye (r = 0.2287), study group - right eye: (r = 0.4374), left eye (r = 0.3580).Conclusion: The area of superficial FAZ of the right and left eyes was significantly higher in the hypertensive patients. The deep FAZ area of both eyes, however showed similar mean areas between the study and control groups.

Foveal avascular zone in oculocutaneous albinism

2021 ◽  
Vol 14 (5) ◽  
pp. e240208
Author(s):  
Hana A Mansour ◽  
Sami Uwaydat ◽  
Muhamad H Yunis ◽  
Ahmad M Mansour
Keyword(s):  
Optical Coherence Tomography ◽  
Optical Coherence Tomography Angiography ◽  
Oculocutaneous Albinism ◽  
Foveal Avascular Zone ◽  
Optical Coherence ◽  
Retinal Capillary ◽  
Avascular Zone ◽  
Capillary Plexus ◽  
Foveal Hypoplasia

Optical coherence tomography angiography imaging in two patients with oculocutaneous albinism, one with severe nystagmus, showed persistence of both the superficial and the deep retinal capillary plexus adding another vascular feature to the foveal hypoplasia.

scholarly journals Automatic segmentation of foveal avascular zone based on adaptive watershed algorithm in retinal optical coherence tomography angiography images

2021 ◽  
Author(s):  
Jian Liu ◽  
Shixin Yan ◽  
Nan Lu ◽  
Dongni Yang ◽  
Chunhui Fan ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Healthy Subjects ◽  
Optical Coherence Tomography Angiography ◽  
Automatic Segmentation ◽  
Qualitative Evaluation ◽  
Foveal Avascular Zone ◽  
Watershed Algorithm ◽  
Strong Positive Correlation ◽  
Optical Coherence ◽  
Avascular Zone

The size and shape of the foveal avascular zone (FAZ) have a strong positive correlation with several vision-threatening retinovascular diseases. The identification, segmentation and analysis of FAZ are of great significance to clinical diagnosis and treatment. We presented an adaptive watershed algorithm to automatically extract FAZ from retinal optical coherence tomography angiography (OCTA) images. For the traditional watershed algorithm, “over-segmentation” is the most common problem. FAZ is often incorrectly divided into multiple regions by redundant “dams”. This paper analyzed the relationship between the “dams” length and the maximum inscribed circle radius of FAZ, and proposed an adaptive watershed algorithm to solve the problem of “over-segmentation”. Here, 132 healthy retinal images and 50 diabetic retinopathy (DR) images were used to verify the accuracy and stability of the algorithm. Three ophthalmologists were invited to make quantitative and qualitative evaluations on the segmentation results of this algorithm. The quantitative evaluation results show that the correlation coefficients between the automatic and manual segmentation results are 0.945 (in healthy subjects) and 0.927 (in DR patients), respectively. For qualitative evaluation, the percentages of “perfect segmentation” (score of 3) and “good segmentation” (score of 2) are 99.4% (in healthy subjects) and 98.7% (in DR patients), respectively. This work promotes the application of watershed algorithm in FAZ segmentation, making it a useful tool for analyzing and diagnosing eye diseases.

scholarly journals Optical Coherence Tomography Angiography Features of Macular Epiretinal Neovascularization In Eales’ Disease: A Case Rreport

2021 ◽  
Author(s):  
Nora Alyousif ◽  
Abrar K. Alsalamah ◽  
Hassan Aldhibi
Keyword(s):  
Optical Coherence Tomography ◽  
Blood Vessels ◽  
Optic Disc ◽  
Optical Coherence Tomography Angiography ◽  
Internal Limiting Membrane ◽  
Peripheral Retina ◽  
Optical Coherence ◽  
Retinal Capillary ◽  
Eales Disease ◽  
The Right

Abstract Background: Eales disease primarily affects the peripheral retina. However, posterior involvement can be seen. Macular epiretinal neovascularization is not commonly seen in Eales disease. This report highlights the morphology and origin of macular epiretinal neovascularization (ERN) using multimodal retinal imaging, including optical coherence tomography angiography (OCTA). Results: A 35-year-old man with no history of systemic disorders presented with gradual decrease of vision in his left eye. Fundus examination of his right eye showed peripheral sclerosed blood vessels, neovascularization of the optic disc and elsewhere, and macular ERN. The view of the left fundus was limited by vitreous haemorrhage. Fluorescein angiography (FA), of the right eye showed widespread peripheral capillary nonperfusion and leakage of dye from the retinal neovascularization and macular ERN. Macular Spectral domain optical coherence tomography (SD-OCT) of the right eye showed an epiretinal membrane and the presence of epiretinal neovascular lesions extending above the internal limiting membrane towards the vitreous. Optical coherence tomography angiography (OCTA) showed multiple tiny blood vessels at the macula that arose from the superficial retinal capillary plexuses and extended toward the vitreous. The corresponding B-scan showed flow signal through these vessels and the signal extend above the internal limiting membrane. Systemic work-up was negative except for strongly positive tuberculin skin testing giving the classic diagnosis of Eales disease. Patient was started on empirical anti-tubercular therapy and oral corticosteroids. Scatter laser photocoagulation was applied to nonperfused retinal zones. Despite adequate scatter laser ablation, the ERN failed to regress fully. Conclusions: Macular ERN can be seen in cases of classic Eales disease. The origin of macular ERN in our case was shown to be from the superficial retinal capillary plexuses. We also noted the slower regression rate of macular ERN as compared to the major neovascularizations of the optic disc and peripheral retina. Further research is needed to establish the pathogenesis of ERN and its optimal management.

Optical coherence tomography angiography in pseudophakic cystoid macular oedema compared to diabetic macular oedema: qualitative and quantitative evaluation of retinal vasculature

2018 ◽  
Vol 102 (12) ◽  
pp. 1684-1690 ◽  
Author(s):  
Riccardo Sacconi ◽  
Eleonora Corbelli ◽  
Adriano Carnevali ◽  
Stefano Mercuri ◽  
Alessandro Rabiolo ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Oedema ◽  
Optical Coherence Tomography Angiography ◽  
Diabetic Macular Oedema ◽  
Foveal Avascular Zone ◽  
Cystoid Macular Oedema ◽  
Control Group ◽  
Retinal Vasculature ◽  
Ophthalmological Examination ◽  
Optical Coherence

AimsTo 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.MethodsIn 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).ResultsDisruption 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).ConclusionsPatients 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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