Conventional Fluorescein Angiography Research Articles

The role of multimodal imaging in characterization and monitoring of choroidal neovascularization secondary to angioid streaks.

To characterize and monitor choroidal neovascularisation (CNV) secondary to angioid streaks (AS) using multimodal imaging and to compare the results with conventional fluorescein angiography (FA). A total of 11 eyes with CNV secondary to AS were included in this retrospective study. Multimodal morphological and functional assessment, including spectral-domain optical coherence tomography (SD-OCT), spectral-domain optical coherence tomography angiography (SD-OCTA), and fundus autofluorescence (FAF), were used to assess for evidence of CNV activity and compared with conventional FA. Morphological features of CNV were analyzed and treatment was continuously monitored using SD-OCT and SD-OCTA. Our results showed that SD-OCTA provided reliable results for the detection of secondary CNV in AS that were comparable to conventional FA. With SD-OCTA, a total of 13 CNVs were detected in 11 eyes and analyzed by means of outer retinal choriocapillaris depth (ORCC) segmentation and the corresponding B-scans. Twelve of the 13 CNVs were classified as active and therefore required treatment. For treatment monitoring during intravitreal therapy (IVT), SD-OCTA was found to be a valuable diagnostic tool over a mean follow-up of 76 weeks. Our study demonstrates that SD-OCTA can be routinely used to identify ill-defined CNV without dye-based angiography, especially in cases of CNV secondary to AS, where Bruch's membrane (BM) defects limit the diagnostic value of FA. Our results showed that non-invasive multimodal imaging facilitates sufficient CNV monitoring and treatment guidance. Further studies are warranted to provide more evidence in this rare retinal disease.

Posterior segment optical coherence tomography: A diagnostic aid in posterior uveitis

Background: Patients with posterior uveitis can develop vision-threatening complications. Optical coherence tomography (OCT) plays an important role in the diagnosis and management of these complications. Aims: The objectives of this study were to describe different retinal morphological characteristics presenting on OCT in patients with posterior uveitis, with an aim to facilitate early diagnosis to initiate specific treatment and also to observe the response to treatment. Materials and Methods: A cross-sectional prospective non-randomized study was undertaken at a tertiary eye care hospital. The study included 30 eyes of 30 patients with posterior uveitis between the period of May 2016 and May 2018. All subjects underwent a set of systemic investigations for etiological diagnosis and complete ophthalmic examination, including OCT (Zeiss Cirrus machine (model number 5000)] imaging). Data were collected and analyzed. A P value of <0.05 was considered statistically significant. Results: The mean patient age was 33.1 ± 4.2 years. Infectious etiology was diagnosed in 13 patients (43.33%) of which toxoplasma chorioretinitis (36.66%) was the most common infection. Among 17 patients with noninfectious uveitis (56.66%), Vogt-Koyanagi-Harada (VKH) disease and multifocal choroiditis (16.67% each) were the most common causes. RPE-Bruch’s membrane abnormalities were seen in 96.67% of patients. Subretinal detachment (26.67%) was the most common type of macular edema on OCT. Significant differences in central foveal thickness posttreatment were noted in cases with VKH syndrome and toxoplasma retinochoroiditis (P < 0.05). Conclusion: OCT is a useful tool complementary to conventional fundus photography and fluorescein angiography in patients with posterior uveitis.

A practical clinical approach to traumatic choroidal rupture

Background: Traumatic choroidal rupture is a posterior segment manifestation of trauma and is more common in closed-globe injuries. It is defined as a tear of the choroid and Bruch’s membrane following blunt trauma. This narrative review summarizes the current literature and provides a practical clinical approach to the diagnosis and management of traumatic choroidal rupture and its complications. Methods: In this narrative review, we searched the PubMed/MEDLINE database using the search term choroidal rupture to provide a practical and updated approach to traumatic choroidal rupture, focusing on its definition, etiology, diagnosis, imaging, management of complications, and prognosis as mentioned in the literature over the last two decades. Results: Traumatic choroidal rupture occurs due to increased tensile stress on the eye wall and is three-fold more common in closed-globe injuries than in open injuries. Subretinal or sub-retinal pigment epithelial hemorrhage and macular edema are early signs. Macular involvement is associated with poor visual prognosis. Damage to Bruch’s membrane increases the risk of subretinal choroidal neovascular membrane (CNVM). Traumatic epiretinal membrane is another complication. Imaging modalities such as spectral-domain optical coherence tomography, indocyanine green angiography, conventional fundus fluorescein angiography, and optical coherence tomography angiography (OCT-A) can be used in diagnosis or monitoring for complications. OCT-A offers unique opportunities for the diagnosis, treatment, and follow-up of both the initial presentation and possible complications. Frequent follow-up has been suggested in the first year after trauma. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection is effective and less invasive in managing CNVM. The visual outcome depends on the location of the rupture, baseline visual acuity, and presence of optic atrophy or macular holes. Risk factors for developing CNVM include rupture involving the macula, longer rupture length or rupture closer to the foveal center, and older age. Conclusions: Choroidal rupture is a posterior segment entity that usually occurs after trauma, compromises choroidal vessels and Bruch’s membrane, and can lead to CNVM. The use of novel noninvasive imaging modalities and efficient anti-VEGF therapy to manage this entity or its subsequent complications produces better visual outcomes. Early diagnosis and frequent follow-up of these patients allow treatment of possible complications, thereby improving the visual prognosis.

USEFULNESS OF ADAPTIVE OPTICS IMAGING IN OPHTHALMOLOGY

Abstract: The methods of imaging posterior segment of the eye are still improving. Conventional colour fundus imaging, fluorescein angiography (FA) and optical coherence tomography (OCT) have become routine in clinical practice to examine retinal diseases. This review presents the results of using adaptive optics (AO) to assess microvascular changes and cone parameters in retinal and systemic diseases. In the future, adaptive optics technology might be used as a non-invasive method in clinical practice not only in retinal diseases but also in diabetology and hypertensiology.

Ultra‐wide field fluorescein angiography in intermediate and posterior uveitis: A retrospective study

AbstractPurpose: To review the diagnostic value of the Ultra‐wide field imaging system Optomap Panoramic 200A (Optos, PLC, Scotland) in patients with intermediate, posterior uveitis or panuveitis of our department and the presence of findings in the periphery of the retina compared to the conventional 7 standard field fluorescein (7SF) angiography, as well as the contribution of the findings to the change of the therapeutic approach.Methods: This is a retrospective study. A medical records electronic search using Medisoft (Medisoft Limited, UK) conducted and included 69 patients and 121 eyes with intermediate, posterior uveitis or panuveitis that underwent Ultra‐wide field fluorescein angiography imaging. Subsequently, imaging was observed for detection of vasculitis, ischemia, neovascularisation and/or choroidal lesions in areas beyond 75° that was detected by conventional fluorescein angiography. The therapeutic approach based on the presence/absence of relevant findings was also reviewed.Results: Out of 121 eyes in total, 67 were classified as intermediate uveitis, 44 as posterior uveitis and 5 as panuveitis. The presence of at least one form of peripheral angiographic finding was noted in 52 eyes, peripheral vasculitis was observed in 40 eyes and peripheral ischemia in 31 eyes. Decision to change the therapeutic approach was decided in 42 eyes overall, 31 of which presented peripheral findings and 11 lacked any. 21 eyes were noted with peripheral findings, but no change of treatment was decided. There was a statistically significant correlation between presence and absence of findings and change of treatment (p < 0.00001). No other statistically significant correlation between treatment alteration and score or specific uveitis type was found.Conclusions: Compared with conventional 7SF imaging, the Ultra‐wide field fluorescein angiography is an extremely useful diagnostic test for the detection of active disease and can significantly change the therapeutic approach in patients with intermediate, posterior uveitis or panuveitis.

Fluorescein angiographic features post-intravitreal bevacizumab for retinopathy of prematurity: can they support rescue laser photocoagulation to the avascular retina

ObjectiveTo study the fluorescein angiography (FA) features post-intravitreal bevacizumab (post-IVB) monotherapy for retinopathy of prematurity (ROP) that may pose risk for late sight-threatening ROP and support rescue laser to the avascular retina. MethodsA retrospective review of 26 infants (47 eyes) with type 1 ROP treated with IVB monotherapy. ResultsAll infants had RetCam and FA performed at an average of 68 weeks postmenstrual age (PMA), 19 at an average 98 weeks PMA, and 10 at an average of 120 weeks PMA. Average gestational age at birth and birth weight were 24.8 weeks (standard deviation [SD] 1.91 weeks) and 683 g (SD 158.85 g), respectively. Average PMA at first IVB was 37 weeks. Eight eyes of 6 infants received repeat IVB for recurrent stage 3 at an average of 46.6 weeks PMA. All infants had inhibited retinal vasculature in zone 2, and 25 of 26 had conventional FA features, which included peripheral leakage, shunts, abnormal branching, and tangles with no late reactivation of ROP until age 3 years. Only 1 infant showed diffuse hyperfluorescence along the regressed proliferation site with a late proliferation necessitating laser to preserve vision. ConclusionsConventional FA features seen in 98% post-IVB monotherapy showed no late complications without rescue laser photocoagulation to the avascular retina.

Potential Impact of DARC Technology in Neuroprotective Therapies

The ability to use and control primary neuroprotective agents is a promising approach for future treatment designs in neurodegenerative diseases, particularly in glaucoma. Previous drug and surgical approaches aim to prevent secondary neuroprotection by reducing intraocular pressure. Imaging procedures play a fundamental role in diagnostics and therapy monitoring. The potential importance of DARC technology (= detection of apoptotic retinal cells: visualisation of retinal cells by fluorescence-labeled annexin V = ANX776 using the cSLO technology) in everyday clinical practice lies in its ease of implementation. The necessary HRT is available in many ophthalmology centres. The use of a fluorescent marker is similar to that of conventional fluorescein angiography. The most important limitation is the individually fluctuating physiological apoptosis of the human retinal ganglion cells, which has to be standardised before this method can be used in everyday clinical practice.

Structural and optical coherence tomography angiography in myopic choroidal neovascularization: Agreement with conventional fluorescein angiography.

To evaluate the agreement between fluorescein angiography and structural optical coherence tomography in diagnosing and monitoring the activity of myopic choroidal neovascularization and to provide a comparative analysis with optical coherence tomography angiography. Thirteen patients with active myopic choroidal neovascularization were prospectively enrolled. At the baseline, 2-month, and 6-month visits, each patient underwent a complete ophthalmological examination, including best-corrected visual acuity assessment, fundus examination, fluorescein angiography, and optical coherence tomography with structural and angiographic assessment. Sensitivity and specificity for all optical coherence tomography parameters were evaluated taking fluorescein angiography as the reference examination. At the baseline, fluorescein angiography confirmed myopic choroidal neovascularization leakage in all patients. Structural optical coherence tomography demonstrated intraretinal or subretinal fluid in 61% of cases, fuzzy borders and absence of external limiting membrane visibility in 84% of cases, and subretinal hyperreflective exudation in 53% of cases. Sensitivity to the presence of retinal fluid and subretinal hyperreflective exudation was lower than sensitivity to fuzzy borders and external limiting membrane visibility, which reached 84%. During ranibizumab therapy, external limiting membrane visibility showed a higher sensitivity (100%) compared with fuzzy borders and subretinal hyperreflective exudation (66.6%) while displaying an equal specificity of 100%. At baseline and final visit, sensitivity increased to 100% when all structural optical coherence tomography parameters were pooled. Optical coherence tomography angiography detected myopic choroidal neovascularization at baseline, 2-month, and 6-month visits in 92%, 76%, and 76% of cases, respectively. The study confirms that the new indicators of myopic choroidal neovascularization activity are more reliable than the presence or absence of retinal fluid. Optical coherence tomography angiography identified myopic choroidal neovascularization in most patients in the diagnostic phase and during treatment monitoring and could be considered as an alternative to fluorescein angiography in selected patients.

Optical coherence tomography angiography (OCT-A) in an animal model of laser-induced choroidal neovascularization

Aim of the study was to compare optical coherence tomography angiography (OCT-A) and conventional fluorescein angiography (FA) for quantitative analysis of the retinal and choroidal vasculature in the animal model of laser-induced choroidal neovascularization (CNV). Therefore, Dark Agouti rats underwent argon laser photocoagulation to induce CNV at D0. In vivo imaging using combined confocal scanner laser ophthalmoscopy (cSLO)-based FA and OCT-A (Heidelberg Engineering GmbH, Heidelberg, Germany) was performed before and immediately after laser treatment as well as at day 2, 7, 14 and 21. OCT-A en-face images were compared to cSLO images obtained by conventional FA topographic uptake recorded using a series of different pre-defined focus settings. For a quantitative comparison of CNV imaging by OCT-A and FA, CNV area, vessel density, number of vessel junctions, total vessel length and number of vessel end points were analyzed. Subsequent ex vivo analyses of the CNV included immunofluorescence staining of vessels in retinal and RPE/choroidal/scleral flatmount preparations. We found, that OCT-A allowed for high-resolution non-invasive imaging of the superficial, intermediate and deep retinal capillary plexus as well as the choroidal blood vessels in rats. Compared with OCT-A, visualization of CNV progression by invasive FA was less accurate, in particular the deep vascular plexus was visualized in more detail by OCT-A. The area of neovascularization was mainly detected in the deep retinal vascular plexus, outer nuclear layer (ONL), ellipsoid zone (EZ) and the choroid. Within the laser lesions, signs of CNV formation occurred at day 7 with progression in size and number of small vessels until day 21. Due to leakage and staining effects, CNV areas appeared significantly larger in FA compared to OCT-A images (p ≤ 0.0001 for all tested layers). Vessel density, number of vessel junctions, total vessel length and number of vessel end points were significantly higher in intermediate vascular plexus (IVP) and deep vascular plexus (DVP) in OCT-A compared to FA images. Overall, CNV area in flatmounts was similar to OCT-A results and much smaller compared to the area of dye leakage by FA. This study demonstrates that in vivo OCT-A imaging in small animals is feasible and allows for precise analysis of the formation of new blood vessel formation in the animal model of laser-induced CNV. Given its superior axial resolution, sensitivity and non-invasiveness compared to conventional FA imaging, OCT-A opens the door for a more detailed evaluation of CNV development in such a model and, thus, enables the analysis of the response to novel therapeutic interventions in longitudinal in vivo studies.

The Role of Optical Coherence Tomography Angiography to Assess Vessel Density and Retinal Perfusion in Diabetic Retinopathy

Diabetic retinopathy (DR) is a chronic microangiopathy that progressively leads to increased vascular permeability, retinal ischemia and, in advanced cases, to retinal neovascularization. Optical coherence tomography angiography (OCTA) is a novel angiography technique based on the principles of OCT that has the ability to enhance the diabetic eyes knowledge by providing high-resolution images of retinal microvasculature blood flow and morphology. In addition to its velocity, feasibility and safety compared to conventional fluorescein angiography (FA), OCTA particularly provides better visualization of superficial and deep retinal layers and offers the possibility to quantitatively measure the areas of non perfusion at the level of the macula and posterior pole.

Optical Coherence Tomography Angiography in Eyes with Indeterminate Choroidal Neovascularization: Results from the AVATAR Study

To evaluate the use of optical coherence tomography angiography (OCTA) to detect choroidal neovascularization (CNV) in eyes with indeterminate CNV features on conventional imaging. The AVATAR study is a prospective observational study of OCTA in patients undergoing routine spectral-domain optical coherence tomography (SD-OCT) for macular disease. Subjects enrolled in the AVATAR study for which CNV was considered as part of a differential diagnosis based on clinical exam and/or prior imaging, but in whom the presence of CNV was not definitive on SD-OCT and fluorescein angiography (FA) imaging. All patients were imaged with the Avanti RTVue XR HD (Optovue, Fremont, CA) and the Cirrus HD-OCT (Zeiss, Oberkochen, Germany) systems. OCTA scans were assessed for the presence or absence of CNV. SD-OCT scans were assessed for the presence of fluid, hyperreflective material, serous pigment epithelial detachment (PED), shallow irregular PED, vitreomacular adhesion, epiretinal membrane, retinal pigment epithelium atrophy and central subfield retinal thickness. Univariate and multivariate logistic regression analyses were performed to identify features on SD-OCT associated with the presence of CNV on OCTA. Twenty-nine eyes of 29 patients met the criteria for inclusion. A CNV lesion was detected on OCTA in 8 (28%) eyes; 21 (72%) eyes were negative for CNV. After adjusted for age, gender and central subfield retinal thickness, the presence of shallow irregular PED [odds ratio, 148; 95% confidence interval, 3.22-6830; p = 0.011], as well as the combinations of intraretinal fluid and sub-retinal pigment epithelium material [odds ratio, 16.8; 95% confidence interval, 1.43-198; p = 0.025] on SD-OCT were significantly associated with the presence of CNV on OCTA. OCTA enabled the identification of CNV that was otherwise indeterminate with prior imaging in select eyes. The presence of a shallow irregular PED as well as intraretinal fluid combined with sub-retinal pigment epithelium material were both associated with the presence of CNV. OCTA may be a valuable adjunct to conventional SD-OCT and FA imaging in the detection and surveillance of CNV, particularly in diagnostic dilemmas.

Peripheral Findings and Retinal Vascular Leakage on Ultra-Widefield Fluorescein Angiography in Patients with Uveitis

To compare ultra-widefield fluorescein angiography (UWFFA) with simulated conventional fluorescein angiography (FA) to evaluate peripheral pathology and leakage and correlate with clinical activity in patients with uveitis. Retrospective chart review. All uveitis patients initially evaluated with UWFFA (Optos 200Tx) between May 2012 and December 2013 were included in this study, including follow-up visits through August2014. Uveitis status was deemed as having active or inactive inflammation based on clinical examination. Changes to therapy, influence on management, and clinical diagnosis were also noted. UWFFA images were compared with simulated 50-degree FA images to evaluate for peripheral lesions, and leakage location was also graded. Imaging characteristics were then correlated with clinical information. Correlation of leakage on UWFFA with clinical inflammation. An initial set of 243 uveitis patients and a total of 1008 eye images were reviewed. When UWFFA was compared with a simulated 50-degree FA image, UWFFA added additional information regarding the presence of peripheral vascular leakage in 25%, peripheral nonperfusion in 14%, peripheral lesions in 6.6%, and peripheral neovascularization in 3.9% of patients. A total of 600 eye images exhibited fluorescein leakage, of which 21% displayed central leakage only, 11% had central and peripheral leakage, 31% had peripheral leakage only, and 37% had diffuse vascular leakage. Based on peripheral findings on widefield angiography, the treatment was changed in 69 patients (28%). Corresponding eye examinations were reviewed for each imaging session, and of 600 eye images with vascular leakage, 567 eye images were also clinically active, which was 95% sensitive as a surrogate indicator of clinical inflammation. Anterior chamber cell and vitreous haze also significantly correlated with leakage on widefield angiography. Retinal vascular leakage on UWFFA reveals increased pathology and leakage compared with conventional angiography, which can influence management, and accurately identifies and correlates with active inflammation in patients with uveitis. A more objective measure of inflammation in the form of leakage exhibited on UWFFA may help standardize treatment and care of patients with uveitis.

The application of ultra-wide-field angiography in the evaluation and management of patients with posterior, and panuveitis

Objective: To evaluate the clinical application of ultra-wide-field fluorescein angiography in posterior and panuveitis patients. Methods: It's a prospective, observational case series study. A total of 82 eyes of 42 patients conformed to the research criteria of posterior and panuveitis. Clinical examinations, conventional fluorescein angiography and ultra-wide-field fluorescein angiograms were performed for each patient. The main outcome was the detection of peripheral retinal changes by ultra-wide-field fluorescein angiography, and how these changes influenced the evaluation and management of the disease. Results: There were 22 male and 20 female in the 42 patients. The mean age of the patients was (43±21) years. Twelve eyes (6 patients) were diagnosed as posterior uveitis, and 70 eyes (36 patients) as panuveitis. Clinical examinations and conventional fluorescein angiography detected active inflammation in 30 eyes (37%), while ultra-wide-field fluorescein angiography identified active inflammation in 48 eyes (59%). In these 18 additional eyes (22%) with active inflammation found by ultra-wide-field fluorescein angiography, non-perfusion area was observed in 4 eyes (5%) and neovascularization was observed in 1 eye (1%). By means of ultra-wide-field fluorescein angiography, a larger area of peripheral vessel leakage showed in 10 eyes (12%) which judged as active inflammation by conventional fluorescein angiography. Additional angiographic changes showed in 46%(21/45) of the eyes with clear etiology, while only in 19%(7/37) of the eyes without clear etiology. According to these findings, treatment strategies adjusted for 12 patients. Conclusions: Ultra-wide-field fluorescein angiography detected more peripheral retinal vascular pathology than conventional fluorescein angiography. The changes found in the periphery were important in the management of uveitis. (Chin J Ophthalmol, 2016, 52: 924-928).

Morphological differences between optic disc collaterals and neovascularization on optical coherence tomography angiography.

To study morphological features of optic disc venous collaterals (OVCs) and neovascularization of optic disc (NVD) on optical coherence tomography angiography (OCTA). Patients with OVCs and NVDs secondary to ischemic retinal diseases were prospectively enrolled. Multimodal imaging was performed using color fundus photography, fluorescein angiography (FA), and OCTA. Morphological evaluation of en-face structural OCT, cross-sectional and en-face OCTA was performed. Twenty eyes (20 patients; OVCs: n = 10 and NVD: n = 10) were included. OVCs appeared as small, loopy vessels distinct from surrounding peripapillary capillaries on OCTA in the radial peripapillary capillary frame. NVDs appeared as a mesh of fine caliber, raised vessels best seen in the vitreous slab of OCTA. Flow signals in these vascular alterations correlated well with hyperfluorescence on FA. OCTA provides improved visualization of NVDs and OVCs in ischemic retinal diseases such as diabetic retinopathy and retinal vein occlusions compared to conventional FA.

Case Series of Pediatric Sickle Retinopathy By Sensitive Clinical Imaging Technologies Suggests Frequent Early Pathology

Introduction: Sickle cell retinopathy (SCR) reflects disease-related vascular injury. Previous studies of pediatric SCR using standard imaging approaches reported retinopathy in <15% of children (Estepp JH, Br J Haematol 161:402;2013). Sensitive clinical retinal imaging modalities of ultra-widefield fluorescein angiography (UWFA), spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCT-A) may better characterize early retinal changes in pediatric SCR. Fluorescein angiography detects retinopathy through dynamic visualization of retinal blood flow. UWFA captures up to twice as much retinal area as conventional fluorescein angiography and is more sensitive in identifying peripheral vascular changes in SCR (Friberg TR, Ophthalmic Surg Lasers Imaging 39:304;2008). SD- OCT and OCT-A utilize reflected light to produce detailed cross-sectional images of the retina and allow visualization of blood flow in retinal layers. To our knowledge, this is the first case series using these technologies in pediatric SCR. Methods: A consecutive series of children with sickle cell disease (SCD) of any phenotype, ages 10-19 years, accepting enrollment are described. Examinations including acuity, standard slit-lamp examination (biomicroscopy), UWFA, SD- OCT and OCT-A were performed according to standard acquisition protocols. Testing is non-invasive except fluorescein angiography, which requires a small volume of intravenous dye.Results: Eight children (mean age 16.3 years; 5 HbSS, 2 HbSC,1 HbS-Beta thalassemia0) were evaluated. Three were on hydroxyurea therapy, 1 on chronic transfusion, 1 on both and 3 on no therapy. No patient had vision disturbance at the time of examination. Biomicroscopic examination revealed sunburst lesions in the mid-peripheral retina in 3 patients and subtle vascular changes in the far periphery of all patients. In contrast, UWFA detected extensive capillary non- perfusion of the peripheral retina with abnormal vascular loops (Goldberg Stage I) in all 8 patients; 3 patients had peripheral arteriovenous anastomoses (Goldberg Stage II) that were undetectable by biomicroscopy. No patient had Goldberg Stages III-V. SD-OCT demonstrated thinning of the temporal macula in 2 patients, and OCT-A of both patients revealed flow voids in both the superficial and deep retinal capillary plexus in the area of thinned retina. Both the SD- OCT and OCT-A abnormalities were undetectable with standard biomicroscopy.Conclusions: All 8 children with SCD in this case series demonstrated evidence of SCR using the combination of standard biomicroscopy, UWFA, SD-OCT, and OCT-A imaging. Findings from these sensitive imaging modalities suggest that pediatric SCR is more prevalent than previously suspected. Additional patients and age-equivalent controls will be included in this report to validate the specificity of findings to SCD. Larger cross-sectional and prospective analyses using sensitive retina imaging are needed to confirm our findings and identify their significance for detecting pathology. If confirmed, these approaches may enhance early screening for patients at risk of vision-threatening consequences of SCR.Supported by the Irving Institute CTSA at CUMC and by 2T35HL007616 (DP). [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

OPTICAL COHERENCE TOMOGRAPHIC ANGIOGRAPHY IN CENTRAL SEROUS CHORIORETINOPATHY.

Using optical coherence tomographic angiography (OCT-angiography), we examined the vasculature of the choriocapillaris in patients with central serous chorioretinopathy (CSC). The prospective observational clinical study included patients with CSC defined by painless loss of central visual acuity and presence of a serous macular detachment as visualized by spectral-domain OCT. All eyes underwent OCT-angiography. Subfoveal choroidal thickness and choriocapillaris width were measured. The study included 26 eyes of 21 patients with a mean age of 47.0 ± 7.9 years (range: 34-65 years). All 26 eyes showed an image pattern of high signal intensity, and 21 eyes additionally demonstrated dilated capillaries in the OCT-angio images. The areas showing abnormalities in the OCT-angiography were congruent with leaking areas in fluorescein angiography or areas with hyperpermeability in indocyanine green angiography. Among 16 patients with unilateral CSC, 1 patient showed a high intensity pattern in the OCT-angiogram in the contralateral, clinically unaffected eye. Parallel to thicker choroidal thickness measurements in affected eyes as compared with contralateral unaffected eyes in unilateral CSC, OCT-angiography revealed significantly thicker choriocapillaris measurements in the affected eyes. Conventional fluorescein angiography did not demonstrate leakage in 14 of 18 eyes with clinically diagnosed CSC. Optical coherence tomographic angiography showed an image pattern of high signal intensity in all eyes with CSC and dilated vessels in the choriocapillaris in most eyes with clinically diagnosed CSC. The results indicate that OCT-angiography may become a noninvasive valuable tool for the diagnosis of CSC in particular and for the diagnosis of macular disorders in general.

Detection of Myopic Choroidal Neovascularization Using Optical Coherence Tomography Angiography

To assess whether optical coherence tomography angiography (OCTA) can be used as an alternative to conventional fundus fluorescein angiography (FFA) for the detection of myopic choroidal neovascularization (CNV). Validity and reliability analysis. Twenty-eight eyes of 26 consecutive Japanese patients with exudative lesions associated with pathologic myopia were included in this institutional study. Myopic CNV was detected in 23 eyes of 22 patients; 5 eyes exhibited simple hemorrhage. The main outcome measure was CNV detection by OCTA and FFA. The CNV area was individually measured by FFA and OCTA. Intraclass correlation coefficients (ICCs) for the CNV area, independently measured by 2 investigators using OCTA and FFA, were determined. OCTA images with sufficient quality for CNV assessment were obtained for 17 eyes with CNV and 4 without. FFA alone detected CNV in all 17 eyes, while OCTA alone detected CNV in 16 (94.1%). The 1 eye for which CNV was not detected by OCTA exhibited a 0.01mm(2) area on FFA. Both FFA and OCTA did not detect CNV in eyes with simple hemorrhage. The mean CNV areas on FFA and OCTA were 0.59 ± 0.56mm(2) and 0.51 ± 0.55mm(2), respectively; the 2 values were significantly correlated (P < .001, r= .86). The ICC (2, 1) values for FFA and OCTA were 0.944 and 0.997, respectively. Our results indicate that OCTA can detect most myopic CNVs if high-quality images are acquired and can preclude the requirement for FFA in these settings.

The Evaluation of Diabetic Macular Ischemia Using Optical Coherence Tomography Angiography.

The purpose of this study was to compare optical coherence tomography (OCT) angiography to standard fluorescein angiography (FA) in the grading of diabetic macular ischemia. In our study, OCT angiography and traditional FA images were acquired from 24 diabetic patients. The level of diabetic macular ischemia in the superficial capillary plexus was graded with standard Early Treatment Diabetic Retinopathy Study (ETDRS) protocols and a comparison between conventional FA and OCT angiography was performed. The deep vascular plexus and choriocapillaris were also graded for macular ischemia. Additionally, flow indices were analyzed for all OCT angiography images. We identified moderate agreement between diabetic macular ischemia grades for conventional FA and OCT angiography (weighted κ of 0.53 and 0.41). In addition, the intergrader agreement for the superficial, deep, and choriocapillaris scores was substantial (weighted κ of 0.65, 0.61, and 0.65, respectively). Finally, the parafoveal flow indices were shown to have a statistically significant relationship with diabetic macular ischemia grades for the superficial capillary plexus (P = 0.04) and choriocapillaris (P = 0.036), with a trend toward significance for the deep capillary plexus (P = 0.13). We demonstrated moderate agreement between diabetic macular ischemia grading results for OCT angiography and conventional FA using standard ETDRS protocols. We also showed that OCT angiography images could be graded for diabetic macular ischemia with substantial intergrader agreement.

Volume-Rendering Optical Coherence Tomography Angiography of Macular Telangiectasia Type 2

To evaluate the vascular structure of eyes with macular telangiectasia type 2 (MacTel2) using volume-rendered optical coherence tomography angiography (OCTA). Retrospective cross-sectional study. A total of 14 consecutive patients (20 eyes) with MacTel2 who had a signal strength score ≥55 and could maintain fixation during the scan process. The eyes were scanned using optical coherence tomography with split-spectrum amplitude decorrelation techniques to derive flow information. Data were extracted and used to create volume-rendered images of the retinal vasculature that could be rotated about 3 different axes for evaluation. Descriptive appraisal of the vascular abnormalities associated with MacTel2. Vessels posterior to the outer boundary of the deep retinal plexus were secondary to retinal thinning, vascular invasion, or a combination of both. These vessels had the same shape and distribution as the late staining seen during conventional fluorescein angiography. Lateral contraction in the temporal macula in 5 eyes created an appearance of vessels radiating from a central locus, which was the site of a right angle vein. Loss of macular tissue as part of the disease process led to a central amalgamation of the inner vascular plexus and the deep vascular plexus, which appeared to be in a state of decline. Subretinal neovascularization originated from the retinal circulation but involved not only the subretinal space but also could infiltrate the remaining, thinned, retina. Volume rendering of OCTA information preserves the 3-dimensional relationships among retinal vascular layers and provides opportunities to visualize retinal vascular abnormalities in unprecedented detail. The retinal vascular leakage and invasion in MacTel2 may arise as a consequence of loss of control with depletion of Müller cells and exposure of the remaining retinal vessels to the more hypoxic environment near the inner segments of the photoreceptors.

A prospective, observational study on the application of ultra-wide-field angiography in the evaluation and management of patients with anterior uveitis.

PurposeEvaluation of peripheral retinal vascular changes in anterior uveitis using ultra-wide-field fluorescein angiography.DesignA prospective, observational study of a case series of patients diagnosed with anterior uveitis.MethodsSetting: Clinical observation at an academic medical center. Patient or Study Population: A total of 65 eyes of 33 patients corresponded with the research criteria of anterior uveitis in the opinion of specialists of Peking University First Hospital. Observation Procedures: Patients were diagnosed primarily through clinical examinations and conventional fluorescein angiography. Subsequently, ultra-wide-field fluorescein angiograms were obtained for each patient. Main Outcome Measures: The main outcome was the detection of peripheral retinal changes by ultra-wide-field fluorescein angiography, and how these changes influenced the evaluation and management of the disease.ResultsPeripheral vessel leakage was detected in 27 eyes (42%) with anterior uveitis, of which 15 eyes displayed active inflammation and 12 eyes displayed inactive inflammation. Peripheral vessel leakage was found in seven of eight eyes with cystoid macular edema. Cystoid macular edema was detected in 7 of 27 eyes (26%) with peripheral vessel leakage, whereas 1 of 38 eyes (3%) did not display peripheral vessel leakage (p<0.01). 44.4% of the patients with peripheral vessel leakage had a specific etiology. The relevant treatment strategies were modified based on the results of the ultra-wide-field fluorescein angiography. 12 patients with peripheral vessel leakage and a quiescent anterior segment were added to those receiving topical glucocorticoids, while 3 patients with serious peripheral vessel leakage and an active anterior segment received a sub-Tenon injection of triamcinolone acetonide.ConclusionsUltra-wide-field fluorescein angiography was very effective in detecting peripheral retinal vascular pathology in anterior uveitis. The changes found in the periphery were important in the evaluation and management of anterior uveitis.