Abstract
This study explored whether rotational three-dimensional (3D) visualization of optical coherence tomography angiography (OCTA) volume data may yield valuable information regarding type 3 macular neovascularization (MNV). In this retrospective, cross-sectional study, we collected data from 15 eyes (13 patients) with treatment-naïve type 3 MNV in their post-nascent stage and age-related macular degeneration (AMD). Subjects were imaged with the SS-OCT system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). The OCTA volume data were processed with a prototype volume projection removal algorithm and then analyzed using volumetric visualization techniques in order to obtain a 3D visualization of the region occupied by type 3 MNV. The two-dimensional and three-dimensional OCTA images were investigated. Mean ± SD age was 75.1 ± 7.4 years. BCVA was 0.42 ± 0.21 LogMAR in the study eyes. Considering the cohort of analyzed eyes, on rotational 3D OCTA images, a total of 35 neovascular lesions (vs 22 lesions detected on 2D OCTA images) rising from the deep vascular complex and variably spanning the outer retinal layers and eventually reaching the RPE/sub-RPE space were detected. Nine of 35 lesions had a saccular shape, while the remaining cases had a filiform shape. On rotational 3D OCTA images, these lesions were inclined on the three planes, instead of perpendicular to the RPE/Bruch’s membrane. In conclusion, this study used an algorithm to obtain rotational three-dimensional visualization of type 3 MNV. This approach seems to increase the detection rate for these lesions and to be useful to offer new insight into type 3 MNV.
Highlights
Optical coherence tomography angiography (OCTA) is a relatively novel imaging technique that produces volumetric angiographic images by performing repeated OCT acquisitions in the same tissue location within a short time to detect scattering differences that relate to motion produced by blood flow in the retinal and choroidal microvasculature[7,8]
The presence of a fibrovascular pigment epithelial detachment (PED) featuring the co-presence of a type 1 macular neovascularization (MNV) was evident in 7 out of 15 eyes on ICGA and/or optical coherence tomography angiography (OCTA) images (Table 1)
These studies demonstrated the presence of retinal vascular elements with collagenous material and Müller cell processes implanting into thick sub-retinal pigment epithelium (RPE) basal laminar deposit[22,23,24,25]
Summary
Optical coherence tomography angiography (OCTA) is a relatively novel imaging technique that produces volumetric angiographic images by performing repeated OCT acquisitions in the same tissue location within a short time to detect scattering differences that relate to motion produced by blood flow in the retinal and choroidal microvasculature[7,8]. Flow information is typically depicted within cross-sectional OCT data by a pseudocolor overlay on the grayscale structural OCT image The latter strategy is limited to the visualization of two-dimensional (2D) images which do not allow for the appreciation of the whole type 3 lesion, which could be oriented on the three dimensions. While the 2D visualization remains the gold standard for evaluating OCTA images, numerous limitations exist, primarily for displaying anatomical entities where both their en face extent and depth information is important to better understand their status and behavior, such as type 3 MNV These shortcomings may be partially addressed with the development of three-dimensional (3D) illustrations, assuming that the acquired OCTA volume enables 3D visualization of the retinal and choroidal microvasculature. Our aim was to understand whether the three-dimensional images generated by this technique yield valuable information regarding the configuration of type 3 lesions
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