The Role of OCT Angiography in the Assessment of Epiretinal Macular Membrane

Background. The aim of this observational study is to assess pre- and postoperative retinochoroidal vascular changes in patients undergoing epiretinal macular membrane (ERM) surgery by using optical coherence tomography angiography (OCTA). Materials and Methods. 23 eyes affected by ERM and those which underwent phacovitrectomy associated with ERM peeling were enrolled. They were evaluated using structural OCT and OCTA before surgery and at 1, 3, and 6 months postoperatively. Results. We found a statistically significant ( p < 0.05) increase in the superficial capillary plexus vessel density (VD) from baseline to the 6-month follow-up. We observed a large increase in both the perfusion density (PD) and the VD of the deep capillary plexus between baseline and the 6-month follow-up ( p < 0.001). A significant decrease in the VD and PD of the choriocapillaris (CC) from baseline to the 1st month and a significant increase in CC perfusion density at the 6-month follow-up compared to the preoperative value were revealed. The FAZ area and perimeter after surgery significantly increased during the follow-up ( p < 0.001) at baseline retinal and choroidal plexi with a lower PD or VD correlated with worse visual acuity ( p < 0.05 for all plexi). At baseline and at the 1-month follow-up, a significant correlation was found with the FAZ area and the FAZ perimeter: a smaller FAZ area or a smaller FAZ perimeter was correlated to a lower visual acuity. Before surgery, negative correlations ( p < 0.05) were found between the Govetto ERM stages and perfusion density of the SCP and the DCP and between the Govetto stages and vessel density of the DCP. Conclusions. In our study, OCTA detected vascular alterations induced by the presence of the ERM, allowing several correlations with functional data. In these patients, OCTA may be useful to add new potential surgical prognostic factors.

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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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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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Evaluation of vessel density in disorganization of retinal inner layers after resolved diabetic macular edema using optical coherence tomography angiography

PLoS ONE ◽

10.1371/journal.pone.0244789 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244789

Author(s):

Gilda Cennamo ◽

Daniela Montorio ◽

Federica Fossataro ◽

Claudia Fossataro ◽

Fausto Tranfa

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Negative Correlation ◽

Optical Coherence Tomography Angiography ◽

Significant Negative Correlation ◽

Vessel Density ◽

Optical Coherence ◽

Capillary Plexus

Purpose To evaluate the retinal vessel density (VD) in the macular region and the foveal avascular zone (FAZ) area using optical coherence tomography angiography (OCTA) in patients with and without disorganization of retinal inner layers (DRILs) after resolution of diabetic macular edema. Methods Thirty-seven eyes of 37 DRIL patients (mean age 63 ± 13.97 years), 30 eyes of 30 no DRIL patients and 35 eyes of 35 controls were enrolled in this study. We evaluated the VD in the macular region of superficial capillary plexus (SCP), deep capillary plexus (DCP) and FAZ area. Results DRIL and no DRIL groups showed decreased VD in SCP and DCP (p<0.05) and a larger FAZ area (p<0.001) compared to controls. However, DRIL patients revealed a statistically significant reduction in VD of SCP (p = 0.041) and a greater FAZ area (p<0.001) with respect to no DRIL patients. We found a significant negative correlation between the VD of the foveal SCP (r = -0.414, p = 0.011), foveal DCP (r = -0.358, p = 0.025) and best corrected visual acuity (BCVA) in DRIL group. Moreover there was a significant positive correlation between the FAZ area (r = 0.425, p = 0.034) and BCVA. Therefore, in presence of DRILs lower VD values of SCP and DCP and a larger FAZ area correlated with a worse visual acuity. In no DRILs group, there was a significant negative correlation between the VD of the foveal DCP and BCVA. Conclusion OCTA highlights the role of retinal vascular ischemia in the pathogenesis of DRILs. This parameter could represent an important functional predictive factor in diabetic patients.

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Perifoveal exudative vascular anomalous complex in a highly myopic eye

Therapeutic Advances in Ophthalmology ◽

10.1177/2515841420947930 ◽

2020 ◽

Vol 12 ◽

pp. 251584142094793

Author(s):

Riccardo Sacconi ◽

Enrico Borrelli ◽

Francesco Bandello ◽

Giuseppe Querques

Keyword(s):

Visual Acuity ◽

Fundus Examination ◽

Corrected Visual Acuity ◽

Capillary Plexus ◽

The Right ◽

Superficial Capillary Plexus ◽

Best Corrected Visual Acuity ◽

Past Conditions ◽

Chorioretinal Degeneration

‘Perifoveal Exudative Vascular Anomalous Complex’ (PEVAC) is a perifoveal, unilateral, isolated, perifoveal aneurysm, in otherwise healthy patients. Here, we report a case of PEVAC in a highly myopic eye of a 86-year-old woman affected by a visual decline in the right eye (best-corrected visual acuity of 20/100). She had no other relevant past conditions and/or ocular impairment. Fundus examination in the right eye showed myopic chorioretinal degeneration with a concomitant PEVAC. Structural optical coherence tomography (OCT) showed a round lesion with a hyperreflective wall associated with intraretinal cystic spaces. OCT-angiography nicely disclosed an isolated large aneurysmal retinal dilation featuring the PEVAC with detectable flow in superficial capillary plexus, deep capillary plexus, and avascular slab. This case highlights the importance of discerning between different vascular disorders of the macula, in order to be able to offer the right treatment and/or follow-up to the patient.

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Secondary choroidal neovascularization due to choroidal osteoma after 9 years follow-up

BMC Ophthalmology ◽

10.1186/s12886-021-02004-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yun Zhang ◽

Jia Fang ◽

Shixin Zhao ◽

Xiangjun She ◽

Jun Wang ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Choroidal Neovascularization ◽

Optical Coherence Tomography Angiography ◽

Fluorescence Angiography ◽

Optical Coherence ◽

Vascular Changes ◽

Choroidal Osteoma ◽

The Right

Abstract Background Choroidal osteoma is a benign intraocular tumor that can increase risk of developing choroidal neovascularization. The visual prognosis is influenced by the tumor location, decalcification status, overlying RPE atrophy, presence of choroidal neovascularization, persistence of subretinal fluid and occurrence of subretinal hemorrhages. Case presentation The authors present a 40-year-old woman diagnosed with choroidal osteoma of the right eye. Her best corrected visual acuity was 12/20 but decreased to 5/20 due to secondary choroidal neovascularization after 8 years follow up. Fundus examination revealed an enlarged choroidal osteoma in most margins at posterior pole with schistose hemorrhage beside macula. Optical coherence tomography angiography revealed unique features in the vascular changes of choroidal neovascularization in choroidal osteoma in the outer retinal layer and choroid capillary layers, and subretinal neovascularization. Indocyanine green fluorescence angiography showed there was hypo-fluorescence at the peripapillary with faint hyper-fluorescence at the macular, corresponding to the location on the fundus photograph. The patient received 3 injections of intravitreal ranibizumab. After 1 year follow up, her visual acuity of the right eye was 18/20 and the CNV had regressed. Conclusions We present the findings and treatment of a case of choroidal osteoma with secondary choroidal neovascularization. Optical coherence tomography angiography combined with FFA and ICGA is used to analysis the characteristics of secondary choroidal neovascularization. Optical coherence tomography angiography can reveal some unique characteristics in the vascular changes compared to fundus fluorescein angiography.

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Relationship between Size of the Foveal Avascular Zone and Carbohydrate Metabolic Disorders during Pregnancy

BioMed Research International ◽

10.1155/2019/3261279 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Masahiko Sugimoto ◽

Yasuko Wakamatsu ◽

Ryohei Miyata ◽

Hisashi Matsubara ◽

Mineo Kondo ◽

...

Keyword(s):

Metabolic Disorders ◽

Optical Coherence Tomography Angiography ◽

Rank Order ◽

Foveal Avascular Zone ◽

Vascular Changes ◽

Normal Individuals ◽

Significant Difference ◽

Avascular Zone ◽

Capillary Plexus ◽

Superficial Capillary Plexus

Aim. To determine whether the area of the foveal avascular zone (FAZ), as a morphological indicator of the microcirculation of the perifoveal capillary network, changes in the carbohydrate metabolism disorders during pregnancy (the gestational age of patients with gestational diabetes mellitus (GDM) and preexisting diabetes (PexD)). Methods. Ten normal individuals and 41 eyes of 41 patients, 28 with GDM and 13 with PexD, were studied. A 3 × 3 mm area of the FAZ of the superficial capillary plexus layer (SCP) and the deep capillary plexus layer (DCP) was determined by optical coherence tomography angiography (OCTA; RS-3000 Advance, NIDEK). The significance of the correlation between the size of the FAZ and the weeks of pregnancy was determined. Results. The area of the FAZ of the SCP was 0.38 ± 0.11 mm2 (normal eyes), 0.41 ± 0.16 mm2 (GDM), and 0.43 ± 0.10 mm2 (PexD). The area of the FAZ of the DCP was 0.78 ± 0.23 mm2 (normal eyes), 0.69 ± 0.16 mm2 (GDM), and 0.79 ± 0.25 mm2 (PexD). No significant difference in the FAZ sizes was observed between the groups. The average number of weeks of pregnancy was 24.1 ± 8.2 weeks in the eyes with GDM and 23.3 ± 11.4 weeks in the eyes with PexD (P>0.05). Significant correlations were found between the size of the FAZ of the SCP and the number of weeks (r = 0.37, P=0.04 for GDM, and r = 0.49, P=0.04 for PexD, Spearman’s rank-order correlation coefficient). Conclusions. For GDM and PexD under established glycemic control, the area of the FAZ is not affected, but vascular changes occurred at the early phase of pregnancy.

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Compensatory contribution of retinal larger vessels to perfusion density in diabetics without retinopathy

Scientific Reports ◽

10.1038/s41598-021-02554-y ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Dulce Milagros Razo Blanco-Hernández ◽

Selma Alin Somilleda-Ventura ◽

Rebeca Chávez-Herrera ◽

María Guadalupe Colas-Calvere ◽

Virgilio Lima-Gómez

Keyword(s):

Regression Model ◽

Cross Sectional Study ◽

Quadratic Equation ◽

Vessel Density ◽

Retinal Vessels ◽

Cross Sectional ◽

Capillary Plexus ◽

Group 2 ◽

Perfusion Density ◽

Superficial Capillary Plexus

AbstractVessel and perfusion densities may decrease before diabetic retinopathy appears; it is unknown whether these changes affect the contribution of vessel density to perfusion density. This was a non-experimental, comparative, prospective, cross-sectional study in non-diabetic subjects (group 1) and diabetics without retinopathy (group 2). Vessel and perfusion densities in the superficial capillary plexus were compared between groups at the center, inner, and full regions and by field (superior, temporal, inferior, nasal) using optical coherence tomography angiography. Coefficients of determination (R2) between vessel and perfusion densities were calculated to find the contribution of larger retinal vessels to perfusion density. Percent differences were used to evaluate the contribution of these vessels to perfusion density in a regression model. There were 62 participants, 31 eyes by group; vessel and perfusion densities as well as the coefficients of determination between them were lower in group 2, especially in the nasal field (R2 0.85 vs. 0.71), which showed a higher contribution of larger retinal vessels to perfusion density. The regression model adjusted to a quadratic equation. In diabetics without retinopathy the contribution of vessel density to perfusion density may decrease; a low vessel density may increase the contribution of larger retinal vessels to perfusion density.

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Effect of axial length on peripapillary microvasculature: An optical coherence tomography angiography study

PLoS ONE ◽

10.1371/journal.pone.0258479 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258479

Author(s):

Kee Sup Park ◽

Hyung Bin Lim ◽

Yong Il Shin ◽

Gi Seok Park ◽

Woo Hyuk Lee ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Axial Length ◽

Optical Coherence Tomography Angiography ◽

Optical Coherence ◽

Capillary Plexus ◽

Group 3 ◽

Group 2 ◽

Perfusion Density ◽

Superficial Capillary Plexus ◽

Group 1

Objective To investigate the effects of axial length (AL) on the peripapillary microvascular density acquired from optical coherence tomography angiography (OCTA). Methods Retrospective observational study. A total of 111 eyes from 111 normal healthy subjects were examined. The subjects were divided into three groups according to the AL: Group 1 (AL: < 24.0 mm; 35 eyes), Group 2 (AL: 24.0–25.99 mm; 37 eyes), and Group 3 (AL: ≥ 26 mm; 39 eyes). Peripapillary OCTA images were acquired using 6× 6 mm angiography scans, and vessel density (VD) and perfusion density (PD) of the superficial capillary plexus were calculated automatically. VD and PD were compared among the three groups according to the distance from the optic disc (inner and outer rings). Linear regression analyses were also performed to identify clinical factors associated with average VD. Results The average ALs of Groups 1–3 were 23.33± 0.57, 25.05± 0.60, and 27.42± 0.82, respectively. Average VD (P = 0.009) and PD (P = 0.029) in the inner ring increased with increasing AL. However, average VD (P < 0.001) and PD (P < 0.001) in the outer ring decreased with AL increased; the same trends were found for the full areas (VD, p<0.001; PD, p = 0.001). Average VDs in the inner and outer rings were not associated (P = 0.938). Conclusions Peripapillary VD and PD were significantly associated with AL. Depending on the distance from the disc, peripapillary VDs and PDs of the inner and outer rings were differentially affected by AL. Physicians should therefore consider the effects of AL in the analyses of peripapillary microvasculature.

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OCTA in macular intraretinal microvascular abnormalities: Retinal vascular density remodeling after panretinal photocoagulation

European Journal of Ophthalmology ◽

10.1177/11206721211059014 ◽

2021 ◽

pp. 112067212110590

Author(s):

Federica Fossataro ◽

Marco Rispoli ◽

Alfredo Pece

Keyword(s):

Diabetic Retinopathy ◽

Optical Coherence Tomography Angiography ◽

Vascular Density ◽

Panretinal Photocoagulation ◽

Flow Area ◽

Non Invasive ◽

Avascular Zone ◽

Capillary Plexus ◽

Superficial Capillary Plexus

Purpose To describe a case of macular intraretinal microvascular abnormality (IRMA) detected with Optical Coherence Tomography Angiography (OCTA) and to show its remodeling and vascular density changes after panretinal photocoagulation (PRP) during an 18-month follow-up. Methods Case report. Results A 22-year-old female patient with proliferative diabetic retinopathy was found to have a small hyperreflective formation with posterior shadow cone and signal flow, located at the temporal margin of the fovea avascular zone (FAZ), identified as macular IRMA with OCTA. Her best-corrected-visual acuity was 20/20. Four months later the macular IRMA was larger and, in its context, there was also an increase in the flow area in B-scan. The patient underwent PRP and after 18 months we observed a regression of macular IRMA and an increase in the superficial capillary plexus vessel density in all sectors in comparison to baseline. Conclusion OCTA is a non-invasive tool that recognize macular IRMA in diabetic retinopathy patient and it could be helpful to follow their qualitative and quantitative vascular evolution over time.

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The role of quantitative deep capillary plexus in the pathogenesis of type 3 macular neovascularization: an optical coherence tomography angiography study

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05330-w ◽

2021 ◽

Author(s):

Marina Concilio ◽

Federica Fossataro ◽

Daniela Montorio ◽

Mariapaola Giordano ◽

Gilda Cennamo

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Early Stage ◽

Study Groups ◽

Control Group ◽

Main Role ◽

Optical Coherence ◽

Capillary Plexus ◽

Type 3

Abstract Purpose To quantitatively investigate the role of deep capillary plexus (DCP) in patients affected by type 3 macular neovascularization (MNV), compared to patients with reticular pseudodrusen (RPD) eyes and healthy controls, using optical coherence tomography angiography (OCTA). Methods In this prospective observational study, a total of seventy-eight eyes of 78 patients were included. Group 1 consisted of 40 eyes of 40 patients with stage 1 of type 3 MNV (22 males, 18 females, mean age 73.7, SD ± 6.60) and group 2 included 38 eyes of 38 patients with RPD (17 males, 21 females, mean age 73.2, SD ± 4.55). The control group included 40 eyes of 40 healthy subjects (20 males, 20 females, mean age 71.4, SD ± 6.36 years). We evaluated the retinal vessel density (VD) of superficial capillary plexus (SCP) and deep capillary plexus (DCP) using OCTA. Results Patients with diagnosis of type 3 MNV showed statistically lower values of VD in DCP with respect to controls and to RPD group (p < 0.001), while there were no statistical differences between RPD and control group in macular region. No significant differences in VD of SCP were detected among the three study groups. Conclusion OCTA provides a reproducible, non-invasive detailed quantitative analysis of retinal vascular features and changing in early-stage type 3 MNV patients, which allowed to shed the light on the main role of DCP ischemia in the development of type 3 MNV.

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