Abstract
BackgroundTo evaluate the efficacy of swept –source optical coherence tomography angiography (SS-OCTA) in grading macular perfusion in retinal vein occlusion.MethodsRetrospective observational case series including patients with different types of retinal vein occlusion (RVO). SS-OCTA utilizes OCTARA algorithm to examine the retinal vascular plexuses for the presence of morphological signs of ischemia according to a predetermined grading scheme. The findings were compared with fundus fluorescein angiography (FFA), and swept-source optical coherence tomography (SS-OCT) features. Bivariate correlation, coefficient of determination, and crosstabs procedures were used to calculate inter-variable linear correlation, relative contribution of the tested variables, and multivariate association, respectively.ResultsThe study included 144 eyes of 138 patients. The most common type of RVO was branch retinal vein occlusion (BRVO) (53%). The superficial capillary plexus (SCP) and the deep capillary plexus (DCP) did not correlate with each other in all parameters tested. Increased central macular thickness (CMT) and disrupted retinal outer layers (DROL) were associated with increased severity of ischemia in DCP. Disorganized retinal inner layers (DRIL) correlated significantly with the presence of perifoveal capillary ischemia in the SCP and the DCP. Macular ischemia on FFA correlated with ischemia in the SCP layer only. Increased CMT, DROL and DRIL on SS-OCT, and SCP and DCP ischemia on SS-OCTA contributed significantly to diminished best-corrected visual acuity (BCVA).ConclusionSS-OCTA is more precise in defining the extent and location of maximum ischemic insult following RVO compared to FFA, hence represents a more efficient grader for ischemic damage in the posterior pole. Increased CMT, DRIL, and DROL on SS-OCT, and SCP and DCP ischemia on SS-OCTA are significant predictors of poor visual outcome.
Highlights
To evaluate the efficacy of swept –source optical coherence tomography angiography (SS-OCTA) in grading macular perfusion in retinal vein occlusion
Hypoperfusion of the deep capillary plexus (DCP) could be detrimental to the visual function due to the pivotal role of the DCP in nourishment of the watershed zone that is located between the inner nuclear layer (INL) and the outer plexiform layer (OPL) and that contains neuronal synapses transmitting visual signal from the photoreceptors [9]
fundus fluorescein angiography (FFA) reveals only the superficial capillary plexus (SCP) perfusion. These limitations have been elaborated in several studies that focused on imaging the retinal vascular plexuses using optical coherence tomography angiography (OCTA) technology as alternative to conventional FFA [6, 10,11,12,13]
Summary
To evaluate the efficacy of swept –source optical coherence tomography angiography (SS-OCTA) in grading macular perfusion in retinal vein occlusion. The traditional approach for evaluation of macular perfusion following retinal vein occlusion (RVO) consisted of assessment of the superficial capillary plexus (SCP) using fundus fluorescein angiography (FFA), which relayed information on the morphological alteration of the perifoveal capillary network due to ischemia. These limitations have been elaborated in several studies that focused on imaging the retinal vascular plexuses using optical coherence tomography angiography (OCTA) technology as alternative to conventional FFA [6, 10,11,12,13] Another important limitation of FFA is that it involves intravenous dye injection which renders it an unrealistic and possibly hazardous follow-up imaging modality given the chronic course of RVO and the need for repeated evaluation [14].
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