Microaneurysms visualisation using five different optical coherence tomography angiography devices compared to fluorescein angiography

BackgroundTo compare fluorescein angiography (FA) and five different optical coherence tomography angiography (OCTA) devices and to test their reproducibility in the evaluation of retinal microaneurysms (MAs) secondary to diabetic retinopathy (DR).MethodsOn the same day, patients with DR were imaged with FA and five OCTA devices: prototype Spectralis OCTA, prototype PlexElite, RTVue XR Avanti, AngioPlex and DRI OCT Triton. For all OCTA devices, a 3×3 volume scan pattern was performed. MAs were evaluated for the superficial capillary plexus (SCP) and deep capillary plexus (DCP).ResultsTwenty eyes of 15 patients with DR were included. FA counted a significantly higher number of MAs compared to OCTA devices. Spectralis OCTA obtained a significantly higher number of MAs compared to PlexElite, RTVue XR Avanti, AngioPlex and DRI OCT Triton (p<0.0001). PlexElite and AngioPlex showed a greater number of MAs in the SCP, Spectralis OCTA, RTVue XR Avanti and DRI OCT Triton in the DCP. Higher sensitivity (43.3%) but lowest specificity (54.4%) was observed for Spectralis OCTA compared to other devices. The higher specificity (78.5%) and positive predictive value (83.3%) were observed for DRI OCT Triton.ConclusionsFA remains the best imaging modality to visualise retinal MAs. Spectralis OCTA was able to detect more MAs compared to other devices, likely due to the higher number of B-scans in the scanned area as well as due to the higher number of repeated B-scans. The high variability between OCTA devices should be taken into account for future clinical trials as in clinical practice.

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Fundus Fluorescein Angiography, Optical Coherence Tomography, and Optical Coherence Tomography Angiography Findings in Branch Retinal Vein Occlusion

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0144 ◽

2019 ◽

pp. 83-87

Keyword(s):

Optical Coherence Tomography ◽

Fluorescein Angiography ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Optical Coherence Tomography Angiography ◽

Serous Retinal Detachment ◽

Optical Coherence ◽

Fundus Fluorescein Angiography ◽

Vein Occlusion ◽

Capillary Plexus

Even though the diagnosis depends on clinical examination, in cases with branch retinal vein occlusion (BRVO), fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) provide unique data for follow-up, management and prognosis. In FFA, delay of laminar flow phase in the involved branch, hyperfluorescence due to leakage from the vessel wall in the late phases, hypofluorescence due to the blockage by hemorrhage, and soft exudates, and hyperfluorescence due to macular edema can be detected. In OCT, macular thickening, cystic spaces, serous retinal detachment, hyperreflective dots, disorganization of the outer retinal layers – particularly the photoreceptor inner and outer segments line and the external limiting membrane – can be seen. OCTA reveals non-perfusion, particularly in the deep capillary plexus.

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Optical coherence tomography angiography in diabetic patients without diabetic retinopathy

European Journal of Ophthalmology ◽

10.1177/1120672119895701 ◽

2019 ◽

Vol 30 (6) ◽

pp. 1418-1423 ◽

Cited By ~ 1

Author(s):

Claudio Furino ◽

Grazia Montrone ◽

Maria Vittoria Cicinelli ◽

Stefania Balestra ◽

Maria Oliva Grassi ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Diabetic Retinopathy ◽

Optical Coherence Tomography Angiography ◽

Vessel Density ◽

Foveal Avascular Zone ◽

Diabetic Patients ◽

Optical Coherence ◽

Avascular Zone ◽

Capillary Plexus ◽

Superficial Capillary Plexus

Purpose: To investigate a subset of diabetic patients without diabetic retinopathy with optical coherence tomography angiography, assessing the differences in macular perfusion between diseased eyes and healthy controls. Methods: Monocentric cross-sectional study, including 86 eyes from 43 diabetic patients with no clinical signs of diabetic retinopathy and 78 eyes from 39 controls. Patients underwent 3.0 × 3.0 mm and 4.5 × 4.5 mm swept-source optical coherence tomography angiography. Vessel density (%), foveal avascular zone area (mm2), and avascular density (%) were provided for the superficial capillary plexus and the deep capillary plexus. Results: The foveal avascular zone area at the superficial capillary plexus was larger in the study group compared to controls, irrespective of the area of the slab considered. A meaningful difference was found in the vessel density at the deep capillary plexus of the 3.0 × 3.0 mm slab (p = 0.03). Almost all the variables considered in the study showed a significant within-subject effect. Age significantly correlated with vessel density of superficial capillary plexus on 4.5 × 4.5 mm in both control and diabetic eyes. Conclusion: Diabetic patients with subclinical diabetic retinopathy feature a larger foveal avascular zone at the superficial capillary plexus compared with controls, as well as relative reduction of the vessel density at the deep capillary plexus. These findings might serve as the basis for screening between normal and diabetic subjects.

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Morphological and topographical appearance of microaneurysms on optical coherence tomography angiography

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312258 ◽

2018 ◽

Vol 103 (5) ◽

pp. 630-635 ◽

Cited By ~ 17

Author(s):

Vivian Schreur ◽

Artin Domanian ◽

Bart Liefers ◽

Freerk G Venhuizen ◽

B Jeroen Klevering ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Macular Oedema ◽

Optical Coherence Tomography Angiography ◽

Diabetic Macular Oedema ◽

Optical Coherence ◽

Retinal Area ◽

Fundus Fluorescein Angiography ◽

Morphological Appearance ◽

Capillary Plexus ◽

Retinal Microaneurysms

AimsTo investigate retinal microaneurysms in patients with diabetic macular oedema (DME) by optical coherence tomography angiography (OCTA) according to their location and morphology in relationship to their clinical properties, leakage on fundus fluorescein angiography (FFA) and retinal thickening on structural OCT.MethodsOCTA and FFA images of 31 eyes of 24 subjects were graded for the presence of microaneurysms. The topographical and morphological appearance of microaneurysms on OCTA was evaluated and classified. For each microaneurysm, the presence of focal leakage on FFA and associated retinal thickening on OCT was determined.ResultsOf all microaneurysms flagged on FFA, 295 out of 513 (58%) were also visible on OCTA. Microaneurysms with focal leakage and located in a thickened retinal area were more likely to be detected on OCTA than not leaking microaneurysms in non-thickened retinal areas (p=0.001). Most microaneurysms on OCTA were seen in the intermediate (23%) and deep capillary plexus (22%). Of all microaneurysms visualised on OCTA, saccular microaneurysms were detected most often (31%), as opposed to pedunculated microaneurysms (9%). Irregular, fusiform and mixed fusiform/saccular-shaped microaneurysms had the highest likeliness to leak and to be located in thickened retinal areas (p<0.001, p<0.001 and p=0.001).ConclusionsRetinal microaneurysms in DME could be classified topographically and morphologically by OCTA. OCTA detected less microaneurysms than FFA, and this appeared to be dependent on leakage activity and retinal thickening. Morphological appearance of microaneurysms (irregular, fusiform and mixed saccular/fusiform) was associated with increased leakage activity and retinal thickening.

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Comparison of the Repeatability of Macular Vascular Density Measurements Using Four Optical Coherence Tomography Angiography Systems

Journal of Ophthalmology ◽

10.1155/2019/4372580 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Jingyuan Yang ◽

Mingzhen Yuan ◽

Erqian Wang ◽

Youxin Chen

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Vessel Density ◽

Vascular Density ◽

Optical Coherence ◽

Cross Sectional ◽

Capillary Plexus ◽

Scan Pattern

The aim of this study was to compare the repeatability of optical coherence tomography angiography (OCT-A) measurements of macular vessel density using four OCT-A systems, including Heidelberg Spectralis HRA, Optovue RTVue XR, Zeiss Cirrus HD-OCT 5000, and Topcon DRI OCT Triton. A cross-sectional design was used for this study. The vascular density and vascular length density of the superficial and deep retinal capillary plexuses were imaged with OCT-A using 3 mm and 6 mm scan patterns and were calculated using ImageJ. Comparisons of intraclass correlation coefficients (ICC) were conducted. We found that the OCT-A systems had various levels of repeatability. Zeiss had better repeatability for vessel density than the other systems (overall ICC = 0.936). Optovue had better repeatability for vessel length density when the 6 mm scan pattern was used (ICC = 0.680 and 0.700 for retinal superficial and deep capillary plexus, respectively). We concluded that repeatability varied when different scan patterns of various OCT-A systems were used for imaging the superficial retinal and deep capillary plexuses. Results should be seen as valid only for a given method. The repeatability of various OCT-A systems should be considered in clinical practice and in clinical trials that use OCT-A metrics as outcome measures.

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Early Retinal Flow Changes after Vitreoretinal Surgery in Idiopathic Epiretinal Membrane Using Swept Source Optical Coherence Tomography Angiography

Journal of Clinical Medicine ◽

10.3390/jcm8122067 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2067 ◽

Cited By ~ 7

Author(s):

Rodolfo Mastropasqua ◽

Rossella D’Aloisio ◽

Pasquale Viggiano ◽

Enrico Borrelli ◽

Carla Iafigliola ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Epiretinal Membrane ◽

Optical Coherence Tomography Angiography ◽

Optical Coherence ◽

Vascular Changes ◽

Ilm Peeling ◽

Swept Source ◽

Idiopathic Epiretinal Membrane ◽

Capillary Plexus ◽

Superficial Capillary Plexus

(1) Background: The aim of this observational cross-sectional work was to investigate early retinal vascular changes in patients undergoing idiopathic epiretinal membrane (iERM) surgery using swept source optical coherence tomography angiography (SS-OCTA); (2) Methods: 24 eyes of 24 patients who underwent vitrectomy with internal limiting membrane (ILM) peeling were evaluated pre- and postoperatively using SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). For each eye, five 6x6-mm OCTA volume scans were acquired by two observers independently. The en face images of superficial capillary plexus (SCP) were then exported to imageJ and a semi-automated algorithm was used for subsequent quantitative analysis. Perfusion density (PD), vessel length density (VLD), vessel diameter index (VDI) and vessel tortuosity (VT) of SCP were evaluated in both the parafoveal (2.5 mm diameter) and perifoveal areas (5.5 mm diameter); (3) Results: At OCTA analysis statistically significant differences were found between controls and diseased eyes for all parameters in parafoveal and perifoveal regions (p < 0.001; p < 0.05) except for perifoveal VLD. During 6-month follow up, both anatomical/perfusion and functional parameters showed a statistically significant improvement if compared to preoperative values. In detail, at one-month post vitrectomy, VLD and VT significantly changed in parafoveal region (p = 0.043; p = 0.045), while PD and VDI showed a trend of increase in both parafoveal and perifoveal region. At 6 months after surgery, PD, VLD and VT of parafoveal region significantly improved (p = 0.021, p = 0.018, p = 0.047 respectively). (4) Conclusions: SS-OCTA provides a quantitative and qualitative analysis of the superficial capillary plexus allowing for early vascular changes assessment after vitrectomy with iERM and ILM peeling.

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Optical Coherence Tomography-Angiography of Different Choroidal Neovascularization Subtypes in Wet Age-related Macular Degeneration

Folia Medica ◽

10.2478/folmed-2018-0061 ◽

2019 ◽

Vol 61 (2) ◽

pp. 317-326

Author(s):

Vladimir N. Stavrev ◽

Nelly P. Sivkova ◽

Desislava N. Koleva-Georgieva

Keyword(s):

Optical Coherence Tomography ◽

Macular Degeneration ◽

Fluorescein Angiography ◽

Choroidal Neovascularization ◽

Optical Coherence Tomography Angiography ◽

Vision Loss ◽

Imaging Modality ◽

Age Related Macular Degeneration ◽

Optical Coherence ◽

Age Related

Abstract Age-related macular degeneration is a leading cause of irreversible vision loss in individuals over 55 years of age worldwide. Conventionally, it is divided into two subtypes – dry (non-neovascular) and wet (neovascular) form. Neovascular age-related macular degeneration comprises only 10-15% of all patients but is responsible for more than 80% of blindness related to the disease. It requires early diagnosis and timely treatment. Fluorescein angiography is the current ‘gold standard’ for diagnosing neovascular forms. However, as an invasive procedure, it may be contraindicated in some circumstances and cause serious adverse effects. Optical coherence tomography-angiography is a relatively new, non-invasive and fast imaging modality gaining popularity in the diagnosis of age-related macular degeneration, especially for the neovascular form of the disease. It enables structural and functional information of blood vessels in the retina and choroid, without the need of an intravenous dye. In this study we present and discuss 3 cases of different subtypes of choroidal neovascularization secondary to neovascular age-related macular degeneration. All of them were examined by fluorescein angiography and optical coherence tomography-angiography. The results were qualitatively analyzed.

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Changes In The Macular Vascular Density after Bariatric Surgery Measured by Optical Coherence Tomography Angiography

10.21203/rs.3.rs-303145/v1 ◽

2021 ◽

Author(s):

Malak I ElShazly ◽

Marwa M Salama ◽

Kareem Elessawy

Keyword(s):

Bariatric Surgery ◽

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Macular Thickness ◽

Vascular Density ◽

Optical Coherence ◽

Obese Patients ◽

Short Term ◽

Capillary Plexus ◽

Superficial Capillary Plexus

Abstract Purpose: To evaluate the effect of the weight loss, 3 months after bariatric surgery on the macular thickness and macular vascular density by optical coherence tomography angiography (OCTA).Methods: Forty obese patients were included in this prospective study. Body mass index (BMI), macular thickness (whole, fovea, parafovea and perifovea), macular vascular density (VD) in superficial capillary plexus (whole, fovea, parafovea and perifovea), and macular vascular density in deep capillary plexus (whole, fovea, parafovea and perifovea) were measured before and 3 months after bariatric surgery.Results: The BMI was significantly reduced postoperatively to 43.75±4.4 kg/m2 compared to the preoperative results 55.31±5.1 kg/m2 (p<0.0001). There was significant increase in the macular thickness in the fovea and parafovea postoperatively (p <0.001), but was not significant in the perifovea. There was significant increase in the macular vascular density in the deep capillary plexus postoperatively (p<0.05), but, there was no significant increase in the macular vascular density in the superficial capillary plexus postoperatively (p = 0.4). Significant correlations were detected between the BMI changes and changes in different macular parameters.Conclusion: Bariatric surgery showed significant effect on certain indices in the macular thickness and macular vascular density especially in the deep capillary plexus. Therefore, OCTA is considered a valuable tool to assess the short term changes in the macular microcirculation following significant weight reduction.

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Does Projection Artifact Removal Improve Visualization of Images in Optical Coherence Tomography Angiography?

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419867631 ◽

2019 ◽

Vol 3 (5) ◽

pp. 289-296

Author(s):

Verena R. Juncal ◽

Armin Abadeh ◽

Keyvan Koushan ◽

Alan R. Berger ◽

David R. Chow

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Optical Coherence ◽

Artifact Removal ◽

3 Dimensional ◽

Face Images ◽

En Face ◽

Before And After ◽

Capillary Plexus ◽

Superficial Capillary Plexus

Purpose: This study assesses the frequency of projection artifacts in optical coherence tomography angiography (OCTA) en face images and compares images before and after applying a 3-dimensional projection artifact removal (3D-PAR) algorithm. Methods: This is a single-center, retrospective study that included consecutive patients with any underlying diagnosis who had OCTA obtained from January to March 2017. Patients with various retinal diseases and also healthy eyes were included. All participants underwent imaging with a scan area of 3 mm × 3 mm. The 4 default en face slabs were analyzed: superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR), and choriocapillaris (CC). Images were qualitatively analyzed before and after 3D-PAR by 2 independent graders. Results: None of the SCP images had projection artifact before or after 3D-PAR. Scans of the DCP presented projection artifact in 96.5% of the cases. After 3D-PAR, 14.7% had a complete improvement of projection artifact, 56.5% had a partial improvement, 14.1% were worse, and 14.7% presented no change. In the OR, 2.9% had projection artifact, with a complete improvement after 3D-PAR in 40%, partial improvement in 20%, and no change in 40%. Projection artifact was initially present in 97.6% of the images in the CC. After 3D-PAR, there was a complete improvement in 72.9%, partial improvement in 26.5%, and no change in 0.6%. Choroidal neovascularization (CNV) was detected in 29 eyes (17.1%), and 3D-PAR improved detection of CNV in 12 cases (41.4%). Conclusions: OCTA with 3D-PAR technology minimizes the appearance of projection artifacts in the DCP and CC slabs.

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Optical Coherence Tomography Angiography Analysis of Retinal and Choroidal Vascular Networks during Acute, Relapsing, and Quiescent Stages of Macular Toxoplasma Retinochoroiditis

BioMed Research International ◽

10.1155/2020/4903735 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Georges Azar ◽

Catherine Favard ◽

Sawsen Salah ◽

Antoine Brézin ◽

Vivien Vasseur ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Capillary Density ◽

Vascular Network ◽

Optical Coherence ◽

Vascular Networks ◽

Partial Restoration ◽

Acute Presentation ◽

Capillary Plexus ◽

Superficial Capillary Plexus

Purpose. To highlight the advantages of optical coherence tomography angiography (OCTA) in delineating the morphological features of the retinal and choroidal vascular network during acute, relapsing, and quiescent stages of macular toxoplasma retinochoroiditis. Methods. This prospective study included patients presenting with both active and quiescent ocular toxoplasmoses. OCTA was obtained to diagnose and follow the subsequent vascular network changes at diagnosis and six months after acute presentation. Results. Twenty-three eyes of 23 patients were included. In active lesions, OCTA showed extensive, well-delineated areas of intense hyposignal and perifoveal capillary arcade disruption in the parafoveal superficial capillary plexus (pSCP) and less extensive hyposignal in the parafoveal deep capillary plexus (pDCP). Signals of decreased deep capillary density and disorganization were also seen in the choroid. In nonactive lesions, OCTA demonstrated a homogenous and equally attenuated grayish hyposignal of the pSCP and pDCP and a partial restoration of the nonperfused choroidal areas. Conclusion. OCTA is a useful technique for vascular network analysis in toxoplasma retinochoroiditis. It allows the visualization of the different network changes and behaviors during the different stages of the infection.

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Plexus-specific effect of flicker-light stimulation on the retinal microvasculature assessed with optical coherence tomography angiography

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00495.2020 ◽

2021 ◽

Vol 320 (1) ◽

pp. H23-H28

Author(s):

Martin Kallab ◽

Nikolaus Hommer ◽

Bingyao Tan ◽

Martin Pfister ◽

Andreas Schlatter ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Specific Effect ◽

Optical Coherence ◽

Specific Mechanism ◽

Physiological Importance ◽

Retinal Microvasculature ◽

Capillary Plexus ◽

Flicker Stimulation ◽

Superficial Capillary Plexus

We present vessel density alterations in response to flicker stimulation using optical coherence tomography angiography and identified the superficial capillary plexus as the layer with the most pronounced effect. This points out the physiological importance of the microvasculature in mediating functional hyperemia and suggests a fine-tuned plexus-specific mechanism to meet cellular metabolic demands.

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