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

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.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1135 ◽

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

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Characterizing Flow and Structure of Diabetic Retinal Neovascularization after Intravitreal Anti-VEGF Using Optical Coherence Tomography Angiography: A Pilot Study

Journal of Ophthalmology ◽

10.1155/2021/2942197 ◽

2021 ◽

Vol 2021 ◽

pp. 1-16

Author(s):

Christof Haensli ◽

Katrin Fasler ◽

Daniel Barthelmes ◽

Sandrine A. Zweifel

Keyword(s):

Optical Coherence Tomography ◽

Initial Treatment ◽

Measurement Method ◽

Optical Coherence Tomography Angiography ◽

Case Series ◽

Retinal Neovascularization ◽

Flow Density ◽

Optical Coherence ◽

En Face

Background/Aims. This study evaluates changes of flow and structure of diabetic retinal neovascularization (NV) treated with intravitreal antivascular endothelial growth factor (VEGF) agents using optical coherence tomography angiography (OCTA). With OCTA, retinal blood vessels are visualized at high resolution to separately look at flow and structure information without the need for dye injection. We introduce a new measurement method including and combining information of flow and structure. Methods. Retrospective observational case series. Patients with proliferative diabetic retinopathy (PDR) were treated with intravitreal antiVEGF injections. Retinal NV were repeatedly imaged using swept-source OCTA (Zeiss PlexElite 9000) at baseline, after initial treatment block with 3-4 monthly injections, and during a follow-up period of up to 51 weeks. Change of size and flow density of the structural and angio area of NV was assessed. Results. Nine NV in eight eyes of five patients were analyzed with a median follow-up time of 45 weeks. After the initial treatment block, en face structural area regressed, 18.7% ± 39.0% (95% CI 44.2–6.8%, p = 0.26 ), and en face angio area regressed, 51.9% ± 29.5% (95% CI 32.6 to 71.2%, p = 0.007 ). Flow density within the en face structural area decreased by 33% ± 19.2% (95% CI 20.5–45.5%, p = 0.0077 ). Flow density within the en face angio area decreased by mean 17.9% ± 25.2% (95% CI 1.4–34.4%, p = 0.066 ). In two fellow eyes, NV recurrence could be observed before the onset of vitreous bleeding in one. Conclusion. Our study introduces a new quantitative measurement for NV in PDR, combining structure and flow measurement. The structure area remained after treatment, while its flow density and angio area regressed. We propose this measurement method as a more physiological and possibly more comparable metrics.

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Role of Optical Coherence Tomography Angiography to differentiate Intraretinal microvascular abnormalities and retinal neovascularization in Diabetic Retinopathy

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.1.3891 ◽

2021 ◽

Vol 38 (1) ◽

Author(s):

Abdul Sami Memon ◽

Nasir Ahmed Memon ◽

Pir Salim Mahar

Keyword(s):

Optical Coherence Tomography ◽

Diabetic Retinopathy ◽

Clinical Diagnosis ◽

Proliferative Diabetic Retinopathy ◽

Optical Coherence Tomography Angiography ◽

Retinal Neovascularization ◽

Wide Field ◽

Optical Coherence ◽

Fundus Fluorescein Angiography

Objective: To assess proliferative diabetic retinopathy (PDR) and to describe the difference in angiographic representation of new vessels (NVs) and Intra retinal microvascular abnormalities (IRMA) on optical coherence tomography angiography (OCTA). Methods: A cross-sectional observational study was performed at ISRA Postgraduate Institute of Ophthalmology, Karachi, from March 2018 to September 2018. Forty-two eyes of 21 patients with history of diabetes mellitus (DM) were examined. Twenty-eight eyes with a clinical diagnosis of severe non proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) according to early treatment diabetic retinopathy study (ETDRS) were included and evaluated using Swept source optical coherence tomography angiography (SS-OCTA). Then face wide ﬁeld SS-OCTA images and co registered structural optical coherence tomography (OCT) with ﬂow overlay were used to distinguish the features of IRMA and retinal NVs. Results: Forty-two eyes (21 patients) were examined clinically. Fourteen eyes had moderate NPDR, 15 had severe NPDR and 13 eyes had changes consistent with PDR. After clinical diagnosis, we included 28 eyes in our study based on inclusion criteria. These 28 eyes went through SS-OCTA evaluation and we observed 15 cases with PDR and 13 with severe NPDR changes. The OCTA and clinical diagnosis were similar except in 2 eyes, which is critical but not statically significant showing the importance of this noninvasive technology. Conclusions: Widefield OCTA can work as an alternative to fundus fluorescein angiography (FFA) in the diagnosis of diabetic retinopathy (DR). As it is a non-invasive and depth encoded technique so can be used frequently to monitor the retinal changes and their progression. doi: https://doi.org/10.12669/pjms.38.1.3891 How to cite this:Memon AS, Memon NA, Mahar PS. Role of Optical Coherence Tomography Angiography to differentiate Intraretinal microvascular abnormalities and retinal neovascularization in Diabetic Retinopathy. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.3891 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Observation of Retinal Neovascularization using Optical Coherence Tomography Angiography after Panretinal Photocoagulation for Proliferative Diabetic Retinopathy

10.21203/rs.3.rs-147250/v1 ◽

2021 ◽

Author(s):

Feng He ◽

Fangtian Dong ◽

Weihong Yu

Keyword(s):

Optical Coherence Tomography ◽

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Optical Coherence Tomography Angiography ◽

Quantitative Information ◽

Retinal Neovascularization ◽

Prospective Clinical Study ◽

Panretinal Photocoagulation ◽

Optical Coherence ◽

Fundus Fluorescein Angiography

Abstract Background: To describe the longitudinal changes of retinal neovascularization elsewhere (NVE) on optical coherence tomography angiography (OCTA) in proliferative diabetic retinopathy (PDR) treated by panretinal photocoagulation (PRP). Methods: Each patient included in this prospective clinical study was newly diagnosed PDR and NVE on both fundus fluorescein angiography (FFA) and OCTA. They received PRP of 4 sessions using multi-wavelength laser. Best-corrected visual acuity (BCVA) and OCTA images encompassing NVE were obtained before each PRP session and at 1 month, 3 months, and 6 months. Paired sample t-test was used to investigate differences between BCVA and NVE area before and after PRP. Results: Thirty-two eyes of 32 patients with a mean age of 50.56 ± 7.05 years were included. We found statistically significant reduction in the NVE size at all timepoints compared with the baseline except at 6 months (all P < 0.05). Further analysis demonstrated no statistically significant change of NVE size between two adjacent timepoints except from baseline to post-1st PRP and from 3 months to 6 months (both P < 0.05). BCVA at 3 months showed a statistically significant improvement compared with baseline (P < 0.05), but no significant changes of BCVA were observed during other visits.Conclusions: Using OCTA we found an overall regression in the NVE size following PRP starting as early as 1 week after 1st session and lasting until 3 months. OCTA provides quantitative information of vascular changes and could be a practical method for the longitudinal evaluation of neovascularization.

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Fundus Autofluorescence and Optical Coherence Tomography Findings in Behçets Disease

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0116 ◽

2018 ◽

pp. 338-342

Keyword(s):

Optical Coherence Tomography ◽

Fundus Autofluorescence ◽

Retinal Vasculitis ◽

Response To Treatment ◽

Optical Coherence ◽

Fundus Fluorescein Angiography ◽

Gold Standard Method ◽

Non Invasive ◽

Relapsing Remitting

Behçet s disease is an idiopathic, chronic, multisystemic inflammatory disease with a relapsing-remitting course. Ocular findings are observed in 60-90% of patients and in 50-93% of those, attacks of disease with posterior segment involvement related to retinal damage and visual loss are observed. Although fundus fluorescein angiography is considered as the gold standard method for differential diagnosis of Behçets uveitis and retinal vasculitis, optical coherence tomography and fundus autofluorescence, which are non-invasive imaging methods, are gaining importance for the follow up of disease activity and response to treatment.

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Optical coherence tomography angiography findings in a case with acute posterior multifocal placoid pigment epitheliopathy

European Journal of Ophthalmology ◽

10.1177/1120672118804383 ◽

2018 ◽

Vol 30 (1) ◽

pp. NP1-NP4

Author(s):

Fatih Mehmet Türkcü ◽

Ümit Karaalp ◽

Muhammed Şahin ◽

Alparslan Şahin ◽

Uğur Keklikçi

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Optical Coherence Tomography Angiography ◽

Imaging Technique ◽

Late Phase ◽

Steroid Treatment ◽

Optical Coherence ◽

Noninvasive Imaging Technique ◽

The Right

Twenty-six-year-old male patient admitted to the outpatient clinic with a complaint of decreased vision in both eyes. Visual acuity was 2/10 in the right and 7/10 in the left eye. Fundus examination revealed bilateral yellow-white subretinal lesions involving the macula. Fluorescein angiography showed hypofluorescent lesions in early and hyperflourescent lesions in the late phase. Optical coherence tomography angiography performed in the acute phase showed bilateral hypofluorescency at the choriocapillary level. A diagnosis of acute posterior multifocal placoid pigment epitheliopathy was given. After steroid treatment, visual acuity was improved to 10/10 and earlier lesions in optical coherence tomography angiography were found to be reduced. In conclusion, optical coherence tomography angiography is a noninvasive imaging technique that can be used in the diagnosis and follow-up of acute posterior multifocal placoid pigment epitheliopathy.

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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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Choroidal neovascularization as a complication of primary vitreous retinal lymphoma

European Journal of Ophthalmology ◽

10.1177/1120672120934966 ◽

2020 ◽

pp. 112067212093496

Author(s):

Ya Ma ◽

Huiying Zhao ◽

Xiaoyan Peng

Keyword(s):

Optical Coherence Tomography ◽

Macular Edema ◽

Choroidal Neovascularization ◽

Optical Coherence Tomography Angiography ◽

Intraocular Lymphoma ◽

Exclusion Criterion ◽

Optical Coherence ◽

Fundus Fluorescein Angiography ◽

Subretinal Hyperreflective Material

Purpose: To describe a case of primary vitreous retinal lymphoma (PVRL) complicated with choroidal neovascularization (CNV) and presented with severe macular edema (ME). Case description: A 52-year-old female patient was diagnosed with bilateral PVRL. Optical coherence tomography (OCT) showed severe macular edema (ME) and subretinal hyperreflective material in the left eye at the first visit. No sign of choroidal neovascularization (CNV) was found with fundus fluorescein angiography (FFA) or indocyanine green angiography (ICGA). The ME was resolved after standard intraocular chemotherapy, while the subretinal hyperreflective material remained stable. Optical coherence tomography angiography (OCTA) was performed 2 years after chemotherapy. OCTA revealed a well-circumscribed CNV network in the subretinal hyperreflective material. Conclusion: It is a rare occurrence that CNV and ME developed in this PVRL patient. The presence of ME is not an exclusion criterion for PVRL. This case should also raise awareness of the importance of OCTA as a method for monitoring intraocular lymphoma during follow-up.

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Observation of retinal neovascularization using optical coherence tomography angiography after panretinal photocoagulation for proliferative diabetic retinopathy

BMC Ophthalmology ◽

10.1186/s12886-021-01964-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

H. E. Feng ◽

Y. U. Weihong ◽

Fangtian Dong

Keyword(s):

Optical Coherence Tomography ◽

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Optical Coherence Tomography Angiography ◽

Quantitative Information ◽

Retinal Neovascularization ◽

Prospective Clinical Study ◽

Panretinal Photocoagulation ◽

Optical Coherence ◽

Fundus Fluorescein Angiography

Abstract Background To describe the longitudinal changes in retinal neovascularization elsewhere (NVE) as observed on optical coherence tomography angiography (OCTA) in proliferative diabetic retinopathy (PDR) treated by panretinal photocoagulation (PRP). Methods Each patient included in this prospective clinical study was newly diagnosed with PDR and NVE confirmed by both fundus fluorescein angiography (FFA) and OCTA. They received four sessions of PRP using a multiwavelength laser. Best-corrected visual acuity (BCVA) and OCTA images of the NVE were obtained before each PRP session and at 1 month, 3 months, and 6 months after the PRP treatment. Generalized estimating equations (GEE) was used to investigate the differences between the BCVA and NVE areas before and after PRP. Results Thirty-two eyes of 32 patients with a mean age of 50.56 ± 7.05 years were included. We found a statistically significant reduction in the NVE area at all time points compared with the baseline except at 6 months (all P < 0.05). Further analysis demonstrated no statistically significant change in the NVE area between two adjacent timepoints except from baseline to post-1st PRP (P < 0.05). BCVA at 3 months showed a statistically significant improvement compared with baseline (P < 0.05), but no significant changes in BCVA were observed during the other visits. Conclusions We found an overall regression in the NVE area following PRP starting as early as 1 week after the 1st session and lasting up to 3 months. OCTA provides quantitative information on vascular changes and could be a practical method for the longitudinal evaluation of neovascularization.

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Optical Coherence Tomography Evolution in a Case of X-Linked Juvenile Retinoschisis: 15 Years of Follow-Up

Case Reports in Ophthalmology ◽

10.1159/000480069 ◽

2017 ◽

Vol 8 (3) ◽

pp. 459-464 ◽

Cited By ~ 1

Author(s):

Irini Chatziralli ◽

George Theodossiadis ◽

Dimitrios Brouzas ◽

Ioannis Emfietzoglou ◽

Panagiotis Theodossiadis

Keyword(s):

Optical Coherence Tomography ◽

Male Patient ◽

Optical Coherence ◽

Blurred Vision ◽

Juvenile Retinoschisis ◽

Snellen Chart ◽

Long Term Follow Up ◽

The Right

Purpose: We present the evolution of X-linked juvenile retinoschisis (XLRS) in a male patient using optical coherence tomography (OCT) with a long-term follow-up time of 15 years. Case Description: A 10-year-old male patient presented at the Medical Retina Department of our hospital complaining for blurred vision in both eyes. At the initial presentation in 2001, his best corrected visual acuity (BCVA) was 6/12 in both eyes on the Snellen chart. Based on clinical and OCT findings, the diagnosis of XLRS was made, and it was confirmed by genetic testing. No treatment was performed, but the patient was regularly examined. His BCVA and OCT findings remained relatively stable from 2001 to 2012, when BCVA decreased to 6/18 and 6/24 in the right and left eye, respectively. In 2016, his BCVA was 6/24 and 6/36 in right and left eye, respectively, while OCT depicted significant macular thinning, accompanied by irregularities of the foveal contour in both eyes. Conclusion: Patients with XLRS should be monitored regularly to evaluate the progression of the disease and manage the potential complications.

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