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Polypoidal choroidal vasculopathy: evaluation based on 3-dimension reconstruction of OCT angiography

This article presents a clinical case series that aims to describe novel observations of polypoidal choroidal vasculopathy (PCV) using three-dimensional (3D) reconstruction of swept source OCT angiography (SS-OCTA) images.

The study compares these observations with similar images of type I neovascular age-related macular degeneration (nAMD). The study included patients with PCV in either eye, and the images were obtained and reconstructed in 3D using a pre-specified SS-OCTA imaging protocol.

The researchers evaluated three specific features:

the pattern of flow signal within the polypoidal lesions (PLs).

the configuration of the branching neovascular network (BNN), and.

the spatial arrangement of the PLs in relation to the BNN.

The results showed that all PLs exhibited internal vascular architecture in the form of coil-like loops and none exhibited homogenous flow. Small focal nodules were present within this internal vascular architecture in 70% of cases.

The BNN exhibited a hypermature/mature configuration and was associated with thicker choroid compared to typical nAMD type I neovascularization.

The study concludes that proliferating vasculature is present in both the PL and the BNN, and the configuration suggests that the BNN represents a more chronic and inactive lesion than the PL. The findings provide insights into the nature and structure of PCV and its component parts.

The article is available at the following address: [Polypoidal choroidal vasculopathy: evaluation based on 3-dimension reconstruction of OCT angiography – Ophthalmology Retina].

وقتی تصویر برداری OCTA به درک دوطرفه بودن بیماری Persistent Fetal Vasculature (PFV) کمک میکند

Purpose
To describe abnormalities of the optic nerve microvasculature in patients with persistent fetal vasculature (PFV) and their fellow eyes using optical coherence tomography angiography (OCTA).

Design
Cross-sectional study.

Subjects
50 eyes of 25 patients with PFV who underwent prospective imaging using supine OCTA during examination under anesthesia (EUA) at Bascom Palmer Eye Institute from March 1, 2019, to December 31, 2022.

Methods
OCTA images of the optic nerve of the included patients were analyzed with a primary focus on blood flow. Demographic, clinical, and treatment factors were compared to morphologic changes in the optic disc microvasculature.

Main Outcome Measures
Prevalence of optic nerve microvascular abnormalities on OCTA in the affected and fellow eyes of patients with PFV.

Results
A total of 50 eyes from 25 patients were reviewed, and 28% (7/25) met image quality criteria for OCTA analysis. Optic nerve OCTA showed a persistent hyaloid artery in all (7/7) PFV eyes analyzed. Of these, flow on OCTA was detectable in 57% (4/7).

A Bergmeister’s papilla was evident in 100% (25/25) fellow eyes, of which flow was detected in 68% (17/25).

Fluorescein Angiography (FA) demonstrated blood flow within the stalk in 40% (10/25) of PFV eyes and within the Bergmeister’s papilla in 25% (6/25) of fellow eyes. Similar findings of abnormal blood flow and presence of fibrovascular stalk were seen in both treatment naïve and treated groups.

Conclusions
OCTA allows for high-resolution visualization of subtle vascular abnormalities that are not readily apparent using RetCam FA and may serve as a useful noninvasive test to confirm the patency of the PHA and Bergmeister’s papilla in children. Results of the present study suggest PFV may be a bilateral and asymmetric process.

This is the largest report of pediatric patients with affected and unaffected PFV eyes imaged using OCTA. OCT angiography allows for high-resolution visualization of subtle vascular abnormalities that are not readily apparent using RetCam FA and may serve as a useful noninvasive test to confirm the patency of the PHA and Bergmeister’s papilla in children. Results of the present study and prior literature suggest PFV may be reconsidered as a bilateral, asymmetric process. Continued monitoring with detailed retinal vascular imaging and genetic testing is needed to further elucidate the impact of these findings and the pathophysiology of the disease.

Figure – Representative fundus, FA and OCTA studies in a 7-year-old patient with PFV on the right eye treated with PPL + PPV and Bergmeister papilla on the left eye. A-C correspond to PFV (right) eye. A represents a fundus photography after PPL + PPV treatment. B represents a fluorescein angiogram showing temporal peripheral avascularity (yellow arrowhead). C corresponds to an optical coherence tomography angiography (OCTA) image of the optic nerve. OCTA shows hyporeflective tubular structure of the persistent hyaloid artery (white asteristic) and an elevated tissue structure corresponding to the remaining fibrovascular stalk (white arrow). The persistent hyaloid artery with blood flow is also evidenced (white arrowhead). D-F correspond to fellow (left) eye. D represents a fundus photography without any evidence of Bergmeister papilla. E represents a fluorescein angiogram showing temporal peripheral avascularity (yellow arrowhead). C corresponds to an optical coherence tomography angiography (OCTA) image of the optic nerve. OCTA shows hyporeflective tubular structure of the persistent hyaloid artery (white asteristic) and an elevated tissue structure corresponding to the Bergmeister’s papilla (white arrow). The Bergmeister papilla with blood flow is also evidenced (white arrowhead).

New Imaging Modalities in Retina

New Imagings Modalities in Retina – Fariba Ghasemi MD – 1399.12.18

The Role of AngioVue OCT-Angiography in the Management of AMD

How to optimize integration of OCT-Angiography into your daily practice

Overview

OCT Angiography (OCTA) is a new, non-invasive, motion contrast microvascular imaging modality that is a user- and patient- friendly addition to the diagnostic armamentarium of more than 650 ophthalmology practices worldwide since its introduction two years ago.

Prof. Bruno Lumbroso and Dr Marco Rispoli (Centro Oftalmologico Meterraneo, Rome, Italy) are worldwide pioneers in the development and adoption of this revolutionary technology. With more than two years of experience using AngioVue OCTA, along with numerous publications and books on the subject, they are recognized as having played a pivotal role in leading both the clinical validation of OCTA, and in defining the OCTA educational standards for the Ophthalmology community.

OCTA is very different from traditional dye-based angiographies, both in terms of image acquisition and interpretation. The aim of this webinar is to provide insight about diagnosing and following AMD patients using OCT Angiography, and how to successfully integrate OCTA into your own practice.

Learning Objectives

  1. How to optimize integration of OCT-Angiography into your daily practice.
  2. Special focus on OCTA for AMD.
  3. How to diagnose, classify, and follow-up on Wet AMD in everyday ophthalmology.

Presenters

Prof. Bruno Lumbroso MD Centro Oftalmologico Mediterraneo
Dr Marco Rispoli MD Centro Oftalmologico Mediterraneo

OCTA in Diabetic Retinopathy



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