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Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration.

ABSTRACT: PURPOSE:To detect and quantify choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD) using optical coherence tomography (OCT) angiography. DESIGN:Observational, cross-sectional study. PARTICIPANTS:A total of 5 normal subjects and 5 subjects with neovascular AMD were included. METHODS:A total of 5 eyes with neovascular AMD and 5 normal age-matched controls were scanned by a high-speed (100 000 A-scans/seconds) 1050-nm wavelength swept-source OCT. The macular angiography scan covered a 3 × 3-mm area and comprised 200 × 200 × 8 A-scans acquired in 3.5 seconds. Flow was detected using the split-spectrum amplitude-decorrelation angiography (SSADA) algorithm. Motion artifacts were removed by 3-dimensional (3D) orthogonal registration and merging of 4 scans. The 3D angiography was segmented into 3 layers: inner retina (to show retinal vasculature), outer retina (to identify CNV), and choroid. En face maximum projection was used to obtain 2-dimensional angiograms from the 3 layers. The CNV area and flow index were computed from the en face OCT angiogram of the outer retinal layer. Flow (decorrelation) and structural data were combined in composite color angiograms for both en face and cross-sectional views. MAIN OUTCOME MEASURES:The CNV angiogram, CNV area, and CNV flow index. RESULTS:En face OCT angiograms of CNV showed sizes and locations that were confirmed by fluorescein angiography (FA). Optical coherence tomography angiography provided more distinct vascular network patterns that were less obscured by subretinal hemorrhage. The en face angiograms also showed areas of reduced choroidal flow adjacent to the CNV in all cases and significantly reduced retinal flow in 1 case. Cross-sectional angiograms were used to visualize CNV location relative to the retinal pigment epithelium and Bruch's layer and classify type I and type II CNV. A feeder vessel could be identified in 1 case. Higher flow indexes were associated with larger CNV and type II CNV. CONCLUSIONS:Optical coherence tomography angiography provides depth-resolved information and detailed images of CNV in neovascular AMD. Quantitative information regarding CNV flow and area can be obtained. Further studies are needed to assess the role of quantitative OCT angiography in the evaluation and treatment of neovascular AMD.

SUBMITTER: Jia Y

PROVIDER: S-EPMC4082740 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration.

Jia Yali Y Bailey Steven T ST Wilson David J DJ Tan Ou O Klein Michael L ML Flaxel Christina J CJ Potsaid Benjamin B Liu Jonathan J JJ Lu Chen D CD Kraus Martin F MF Fujimoto James G JG Huang David D

Ophthalmology 20140327 7

<h4>Purpose</h4>To detect and quantify choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD) using optical coherence tomography (OCT) angiography.<h4>Design</h4>Observational, cross-sectional study.<h4>Participants</h4>A total of 5 normal subjects and 5 subjects with neovascular AMD were included.<h4>Methods</h4>A total of 5 eyes with neovascular AMD and 5 normal age-matched controls were scanned by a high-speed (100 000 A-scans/seconds) 1050-nm wavelength sw ...[more]

PMID: 24679442

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Project description:BackgroundOCT-A is a recent imaging technique allowing a non-invasive assessment of the retinal and choroidal microvasculature, providing valuable data for the diagnosis and monitoring of wet AMD. We aim to determine the diagnosis accuracy, describe the morphological features, and assess the clinical activity of MNV in wet AMD using OCT-A.Materials and methodsWe conducted a descriptive cross-sectional study over a 15-month period. We enrolled patients with treatment-naive and treated MNV secondary to wet AMD. Macular OCT-A images were obtained using a swept-source OCT-A device (Triton SS-OCT, Topcon, Tokyo, Japan). Morphologic characteristics and semi-automated measurements were analyzed on the en face projection OCT-Angiograms. For the qualitative analysis, determined the sensitivity of detection of the MNV using OCTA. When detected, we described its shape, branching pattern, anastomoses and loops, and vessel termination. We looked for the halo sign and the feeder vessel. We then defined the lesion's "pattern" reflecting its exudative activity. For the quantitative analysis, we measured the lesion's area in square millimeters, when its borders were clearly defined.Results70 eyes from 55 patients were enrolled in this study. Type 1 MNV was identified in 57,1% eyes, type 2 in 21,4%, mixed type 1 and2 in 1,4%, type 3 in 1,4% and unclassified fibrotic MNV in 18,6%. 55,7% were active and 44,3% were inactive. Sensitivity of detection was 85% for type 1 lesions, 100% for type 2, mixed and type 3 lesions, and 92% for unclassified fibrotic lesions. It was 84,6% for active lesions and 96,8% for inactive lesions. For each detected lesion, shape was well-defined (medusa, glomerulus, seafan), long liner vessels or ill-defined. Branching pattern was dense or loose. Anastomoses and vascular loops were numerous or few. Termination was in an anastomotic arcade or in a dead-tree aspect. Halo sign was present or absent and feeder vessel was detected or not. All types combined, 41,3% of the lesions were "pattern I" and 58,7% were pattern II. We reported a correlation rate of 84,8% between the lesion's activity on MI and « pattern I » on OCT-A, and of 96,6% between absence of activity signs on MI and « pattern II » on OCT-A The mean area of inactive lesions was slightly larger than that of active lesions with respective values of 3.86 mm2 and 2.92 mm2.ConclusionOCT-A is a non-invasive, safe, and reproducible retinal imaging technique with a high sensitivity of detection of MNV in AMD. It provides useful qualitative and quantitative data. The involvement of OCT-A in the treatment decision for MNV in AMD is linked to identifying the "pattern" of the lesion reflecting its active or inactive status.

Project description:PurposeTo examine changes in retinal vasculature and ganglion cell layer (GCL) thickness in intermediate age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA).MethodsZeiss Cirrus Angioplex OCTA 6 × 6 mm scans and a macula 512 × 128 cube scans of the central retina were taken of 63 eyes with intermediate AMD and 51 control eyes. For OCTA scans, the superficial and deep capillary plexus were automatically segmented and vascular density quantified as total number of pixels contributing to the blood flow signal detectable by OCTA. Images were then skeletonized and vessel length, diameter index, morphology, and branching complexity determined. Foveal avascular zone (FAZ) characteristics and GCL thickness were extracted from in-built Angioplex software.ResultsVascular density was significantly reduced in the superficial capillary plexus of AMD eyes compared with normal eyes, particularly in the superior quadrant (42.4% ± 1.6% vs. 43.2% ± 1.4%; P < 0.05). A nonsignificant reduction was also seen in the deep capillary plexus (P = 0.06). Total vessel length and average vessel diameter were all significantly decreased in AMD eyes suggesting density changes were related to decreased vessel number and caliber. Vascular complexity and number of branch points was significantly decreased in the deep capillary plexus (P < 0.05) suggesting loss or significantly reduced flow of vessels. Average GCL thickness was also significantly reduced in the AMD eyes (P < 0.05). No significant changes in FAZ parameters were observed in AMD eyes.ConclusionsThis study suggests intermediate AMD affects both the quantity and morphology of inner retinal vasculature and may be associated with changes in inner retinal structure. This work builds upon the notion that AMD pathogenesis may extends beyond the outer retina.Translational relevanceBetter understanding of retinal vascular changes in AMD can provide insights in the development of treatment and prevention protocols for these diseases.

Dataset Information

Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration.

Publications

Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration.

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