1
|
Fu Y, Zhang Z, Webster KA, Paulus YM. Treatment Strategies for Anti-VEGF Resistance in Neovascular Age-Related Macular Degeneration by Targeting Arteriolar Choroidal Neovascularization. Biomolecules 2024; 14:252. [PMID: 38540673 PMCID: PMC10968528 DOI: 10.3390/biom14030252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 05/04/2024] Open
Abstract
Despite extensive use of intravitreal anti-vascular endothelial growth factor (anti-VEGF) biologics for over a decade, neovascular age-related macular degeneration (nAMD) or choroidal neovascularization (CNV) continues to be a major cause of irreversible vision loss in developed countries. Many nAMD patients demonstrate persistent disease activity or experience declining responses over time despite anti-VEGF treatment. The underlying mechanisms of anti-VEGF resistance are poorly understood, and no effective treatment strategies are available to date. Here we review evidence from animal models and clinical studies that supports the roles of neovascular remodeling and arteriolar CNV formation in anti-VEGF resistance. Cholesterol dysregulation, inflammation, and ensuing macrophage activation are critically involved in arteriolar CNV formation and anti-VEGF resistance. Combination therapy by neutralizing VEGF and enhancing cholesterol removal from macrophages is a promising strategy to combat anti-VEGF resistance in CNV.
Collapse
Affiliation(s)
- Yingbin Fu
- Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030, USA; (Z.Z.); (K.A.W.)
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zhao Zhang
- Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030, USA; (Z.Z.); (K.A.W.)
| | - Keith A. Webster
- Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030, USA; (Z.Z.); (K.A.W.)
- Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Yannis M. Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA;
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48105, USA
| |
Collapse
|
2
|
Montesel A, Hagag AM, Chandra S, Muhammed RP, Thottarath S, Chandak S, Sivaprasad S. Quantitative response of macular neovascularisation to loading phase of aflibercept in neovascular age-related macular degeneration. Eye (Lond) 2023; 37:3648-3655. [PMID: 37258659 PMCID: PMC10686403 DOI: 10.1038/s41433-023-02574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE To evaluate quantitative morphological changes in macular neovascularisation (MNV) network after aflibercept therapy in neovascular age-related macular degeneration (nAMD) patients. METHODS Consecutive treatment-naïve patients with optical coherence tomography (OCT) angiography confirmed MNV due to nAMD who completed a loading phase of intravitreal aflibercept injections. A quantitative analysis of the vascular network remodelling was performed using a computational software (Angiotool). RESULTS A total of 53 eyes of 52 patients were included in the analysis. The total MNV area decreased significantly after three aflibercept injections (p = 0.003). Total vessel area and vessel density decreased respectively of 20% and 12% at V3 (p < 0.001 in both cases). Other parameters that reduced significantly were total vessel length, average vessel length and density of vascular junctions (p = 0.018, p = 0.002, and p = 0.044, respectively). The number of vascular endpoints (p = 0.001) and lacunarity (p = 0.011) increased significantly, whilst the number of vascular junctions did not vary significantly (p = 0.068). Changes in vascular metrics were predominantly driven by MNV type 1 and 2. No clear relationship was observed between any of the vascular metrics and the macular fluid status. CONCLUSION Although objective quantification of vascular parameters showed a significant remodelling of the MNV post-loading phase of aflibercept in type 1 and 2 MNV subtypes, none of the quantified vascular metrics correlated to the macular fluid response. These findings highlight a dissociation of anti-angiogenic and anti-permeability properties of aflibercept therapy during the loading phase.
Collapse
Affiliation(s)
- Andrea Montesel
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, UK
| | - Ahmed M Hagag
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, UK
- Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Shruti Chandra
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, UK
- Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Raheeba Pakeer Muhammed
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, UK
| | - Sridevi Thottarath
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, UK
| | - Swati Chandak
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, UK.
- Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK.
| |
Collapse
|
3
|
Park JB, Kim K, Kang MS, Kim ES, Yu SY. Optical coherence tomography angiography biomarkers in a bi-monthly maintenance dosing aflibercept in patients with neovascular age-related macular degeneration. BMC Ophthalmol 2023; 23:314. [PMID: 37438681 DOI: 10.1186/s12886-023-03039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE To evaluate the correlations between swept-source optical coherence tomography angiography (SS-OCTA) parameters and clinical outcomes in eyes with neovascular age-related macular degeneration (nAMD) administered a bimonthly intravitreal aflibercept regimen. METHODS This prospective, single-arm, interventional study enrolled 33 patients with treatment-naïve nAMD. The eyes received three monthly aflibercept injections followed by five bi-monthly regimens (total 50 weeks). The structural parameters including central subfield thickness (CST) and 5 mm pigment epithelial detachment (PED) volume and microvascular parameters including macular neovascularization (MNV) area, vessel density (VD), and vessel length density (VLD) were recorded every before and 1 week after treatment. RESULTS Patients who gained > 5 letters of best-corrected visual acuity (BCVA) from the baseline showed greater decreases in VD and VLD during the loading phase. Patients without recurrent or persistent fluid during the maintenance phase showed greater decreases in CST and 5 mm PED volume after the first injection. The decrease in mean VD during the loading phase was significantly correlated with the final BCVA (r = -0.820, p = 0.004). Moreover, the decrease in mean VLD during the loading phase was significantly correlated with the improvement in the final BCVA (r = -0.726, p = 0.017). CONCLUSIONS The decrease in mean VD during the loading phase was significantly negatively correlated with the final BCVA at the last visit. The decrease in mean VLD during the loading phase, mean CST during the loading phase, and the improvement in final BCVA showed significant correlations. Therefore, early changes in OCTA microvascular and OCT structural parameters could help predict clinical outcomes in nAMD. TRIAL REGISTRATION The trial was registered with the Clinical Research Information Service (CRIS), which joined the WHO International Clinical Trials Registry Platform (ICTRP) (Registration number: KCT0007375, Date of first trial registration: 10/06/2022).
Collapse
Affiliation(s)
- Jong Beom Park
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, 23, Kyungheedae-ro,, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, 23, Kyungheedae-ro,, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Min Seok Kang
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, 23, Kyungheedae-ro,, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, 23, Kyungheedae-ro,, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, 23, Kyungheedae-ro,, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| |
Collapse
|
4
|
Adrean SD, Chaili S, Pirouz A, Grant S. Results of patients with neovascular age-related macular degeneration managed by a treat-extend-stop protocol without recurrence. Graefes Arch Clin Exp Ophthalmol 2021; 259:3665-3673. [PMID: 34251484 DOI: 10.1007/s00417-021-05283-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/05/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess vision, injection quantity, initial lesion size, and final anatomic status in patients with nAMD completing the treat-extend-stop (TES) protocol. METHODS Patients with nAMD received ≥ 3 monthly anti-VEGF injections followed by 1-2 week injection interval extensions, with intra/subretinal fluid resolution on SD-OCT, to 12 weeks. With quiescent disease, and 2 quarterly injections, patients were monitored alone beginning at 4 weeks extending by 1-2 week intervals until quarterly monitoring. RESULTS Eighty-eight of 143 eyes with nAMD completed the TES protocol without disease recurrence. Sixteen (18.2%) developed sub-foveal geographic atrophy (GA), 25 (28.4%) developed fibrovascular scarring (FV) and 47 (53.4%) developed regressed choroidal neovascularization (rCNV) with 16.9 ± 13.3 average injections between the 3 groups which was not statistically significant. Average treatment time was 30.3 ± 26.1 months and subsequent follow-up was 23.2 ± 19.8 months. Average lesion size for FV was 18.77 ± 10.8mm2 vs. GA at 12.00 ± 9.99mm2 vs. regressed CNV at 7.12 ± 6.5mm2 (p < 0.05). Pre, post, and final vision for GA was 39.6 letters (20/160) vs. 32.7 letters (20/200 + 2, p = 0.4725) vs. 25.0 letters (20/320, p = 0.0865); FV was 22.4 letters (20/400 + 2) vs. 11.6 letters (20/640, p = 0.0351) vs. 11.0 letters (20/640 + 1, p = 0.0226), and rCNV was 56.4 letters (20/80 + 1) vs. 69.5 letters (20/40, p < 0.001) vs. 67.3 letters (20/40-2, p = 0.0016). In the rCNV group, 17/46 eyes gained ≥ 3 lines and 30/46 eyes achieved ≥ 20/40 vision. Non-central GA expanded 0.226 ± 0.126 mm vs. 0.225 ± 0.098 mm during and after treatment completion over 24 months (p = 0.99). CONCLUSIONS Central GA or FV portends worse visual outcomes vs. rCNV after cessation of therapy. Anti-VEGF therapy may not affect the rate of GA expansion. Final anatomic character and location are key determinants of final vision.
Collapse
Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA.
| | - Siyang Chaili
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Ash Pirouz
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
| | - Scott Grant
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
| |
Collapse
|
5
|
Flow pattern and perforating vessels in three different phases of myopic choroidal neovascularization seen by swept-source optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2021; 259:2615-2624. [PMID: 33687562 DOI: 10.1007/s00417-021-05134-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/25/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To compare the choroidal neovascularization (CNV) flow patterns and the relationship between perforating vessels (PVs) and CNV in the three different stages of networks in myopic CNV (mCNV) using swept-source optical coherence tomography angiography (SS-OCTA). METHODS This retrospective study included 28 eyes with mCNV that was divided into three phases (active, scar, and atrophic) and observed by SS-OCTA. SS-OCTA findings, with special focus on the relationship between the PVs and CNV, were compared among the three phases. RESULTS Overall, the CNV signal was detected in 31 of the 34 areas of CNV (91%); in the active, scar, and atrophic phases, respectively, CNV signals were detected in eight of eight areas of CNV (100%), 10 of 11 areas of CNV (91%), and 13 of 15 areas of CNV (86%). Two signal patterns were observed in each phase, i.e., dense and loop; in the atrophic phase, seven eyes were unclassifiable. The ratio between the dense and loop patterns did not differ significantly among the phases. In 30 of 34 areas of CNV for which clear images were obtained, the PVs and CNV were connected directly or indirectly in 19 area of CNV, and in five areas of CNV, trunk-like vessels were connected to the PVs within the CNV. The numbers of foveal or parafoveal CNVs accompanied by PVs were significantly (p=0.0048) greater than those of the extrafoveal CNV. CONCLUSIONS OCTA provides detailed observation of mCNV and the relationship between CNV and PVs. Although the CNV signal pattern does not differ depending on the degree of atrophy, there are cases in which only the trunk-like vessels connect to the PVs within the CNV in the atrophic phase without CNV flow signal.
Collapse
|
6
|
Relapse of pathological angiogenesis: functional role of the basement membrane and potential treatment strategies. Exp Mol Med 2021; 53:189-201. [PMID: 33589713 PMCID: PMC8080572 DOI: 10.1038/s12276-021-00566-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/31/2023] Open
Abstract
Blinding eye diseases such as corneal neovascularization, proliferative diabetic retinopathy, and age-related macular degeneration are driven by pathological angiogenesis. In cancer, angiogenesis is key for tumor growth and metastasis. Current antiangiogenic treatments applied clinically interfere with the VEGF signaling pathway-the main angiogenic pathway-to inhibit angiogenesis. These treatments are, however, only partially effective in regressing new pathologic vessels, and the disease relapses following cessation of treatment. Moreover, the relapse of pathological angiogenesis can be rapid, aggressive and more difficult to treat than angiogenesis in the initial phase. The manner in which relapse occurs is poorly understood; however, recent studies have begun to shed light on the mechanisms underlying the revascularization process. Hypotheses have been generated to explain the rapid angiogenic relapse and increased resistance of relapsed disease to treatment. In this context, the present review summarizes knowledge of the various mechanisms of disease relapse gained from different experimental models of pathological angiogenesis. In addition, the basement membrane-a remnant of regressed vessels-is examined in detail to discuss its potential role in disease relapse. Finally, approaches for gaining a better understanding of the relapse process are discussed, including prospects for the management of relapse in the context of disease.
Collapse
|
7
|
Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration. J Clin Med 2021; 10:jcm10040751. [PMID: 33668537 PMCID: PMC7918036 DOI: 10.3390/jcm10040751] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/11/2022] Open
Abstract
The advent of optical coherence tomography angiography (OCTA) has allowed for remarkable advancements in our understanding of the role of the choriocapillaris in age-related macular degeneration (AMD). As a relatively new imaging modality, techniques to analyze and quantify choriocapillaris images are still evolving. Quantification of the choriocapillaris requires careful consideration of many factors, including the type of OCTA device, segmentation of the choriocapillaris slab, image processing techniques, and thresholding method. OCTA imaging shows that the choriocapillaris is impaired in intermediate non-neovascular AMD, and the severity of impairment may predict the advancement of disease. In advanced atrophic AMD, the choriocapillaris is severely impaired underneath the area of geographic atrophy, and the level of impairment surrounding the lesion predicts the rate of atrophy enlargement. Macular neovascularization can be readily identified and classified using OCTA, but it is still unclear if neovascularization features with OCTA can predict the lesion’s level of activity. The choriocapillaris surrounding macular neovascularization is impaired while the more peripheral choriocapillaris is spared, implying that choriocapillaris disruption may drive neovascularization growth. With continued innovation in OCTA image acquisition and analysis methods, advancement in clinical applications and pathophysiologic discoveries in AMD are set to follow.
Collapse
|
8
|
Greig EC, Duker JS, Waheed NK. A practical guide to optical coherence tomography angiography interpretation. Int J Retina Vitreous 2020; 6:55. [PMID: 33292740 PMCID: PMC7666474 DOI: 10.1186/s40942-020-00262-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022] Open
Abstract
Background Optical coherence tomography angiography (OCTA) can image the retinal vasculature in vivo, without the need for contrast dye. This technology has been commercially available since 2014, however, much of its use has been limited to the research setting. Over time, more clinical practices have adopted OCTA imaging. While countless publications detail OCTA’s use for the study of retinal microvasculature, few studies outline OCTA’s clinical utility. Body This review provides an overview of OCTA imaging and details tips for successful interpretation. The review begins with a summary of OCTA technology and artifacts that arise from image acquisition. New methods and best practices to prevent image artifacts are discussed. OCTA has the unique ability among retinovascular imaging modalities to individually visualize each retinal plexus. Slabs offered in standard OCTA devices are reviewed, and clinical uses for each slab are outlined. Lastly, the use of OCTA for the clinical interpretation of retinal pathology, such as diabetic retinopathy and age-related macular degeneration, is discussed. Conclusion OCTA is evolving from a scientific tool to a clinical imaging device. This review provides a toolkit for successful image interpretation in a clinical setting.
Collapse
Affiliation(s)
- Eugenia Custo Greig
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
| |
Collapse
|
9
|
Cheng LN, Lin YX, Liu L, Zhang XH, Xue YQ, Zhou SD, Liu ZL, Zhang H. Assessment of conbercept therapy for high myopia macular neovascularization by optical coherence tomography angiography. Sci Rep 2020; 10:16959. [PMID: 33046787 PMCID: PMC7550325 DOI: 10.1038/s41598-020-74073-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022] Open
Abstract
This study aimed to evaluate the efficacy and safety of the intravitreal injection of conbercept in the treatment of macular neovascularization (MNV) secondary to high myopia and to observe the application of optical coherence tomography angiography (OCTA) in the treatment follow-up. We reviewed the medical records of 20 patients (21 eyes) with MNV secondary to high myopia who were enrolled in the Department of Ophthalmology of the First Hospital of China Medical University between May 2018 and January 2020. Each patient received one or more intravitreal injections of conbercept (0.5 mg/0.05 mL). The treatment was conducted according to a 1 + PRN (pro re nata) regimen. The changes of best corrected visual acuity (BCVA), central macular thickness (CMT), and selected MNV and flow areas measured by OCTA were observed over a 6-month follow-up period. The mean logarithm of the minimum angle of resolution (logMAR) BCVA was 1.03 ± 0.61 before treatment and improved to 0.83 ± 0.59 (P = 0.007), 0.78 ± 0.62 (P = 0.001), 0.81 ± 0.73 (P = 0.027), and 0.79 ± 0.72 (P = 0.023) at 1 month, 2 months, 3 months, and 6 months after treatment, respectively. The mean CMT was 358.16 ± 206.11 μm before treatment and decreased to 295.38 ± 178.70 μm (P = 0.003), 288.34 ± 165.60 μm (P = 0.004), 284.36 ± 163.07 μm (P = 0.005), and 283.00 ± 160.32 μm (P = 0.004) at 1 month, 2 months, 3 months, and 6 months after treatment, respectively. Nineteen eyes (90.5%) had stable or improved vision at 6 months of follow-up. One month after conbercept injection, in OCTA images, the small-diameter blood vessels of the MNV decreased, the intertwined small blood vessels decreased or even disappeared, and the main or larger-diameter blood vessels were still present. The mean selected MNV and blood flow areas were 0.62 ± 0.81 and 0.22 ± 0.27 mm2, respectively, before treatment and decreased to 0.23 ± 0.33 and 0.07 ± 0.08 mm2 (P = 0.04 for both), respectively, 1 month after treatment. No drug-related systemic or ocular adverse effects were observed. Our results suggest that conbercept can effectively and safely improve BCVA and reduce CMT in patients with myopic MVN (mMNV). OCTA can be used to observe MNV area, blood flow area, and MNV morphological changes after treatment with conbercept, thus providing a reference for treatment follow-up.
Collapse
Affiliation(s)
- Lu-Na Cheng
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Yu-Xi Lin
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Lei Liu
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Department of Public Service, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Xu-He Zhang
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Yan-Qi Xue
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Sheng-Di Zhou
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Zhe-Li Liu
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Han Zhang
- Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.
| |
Collapse
|
10
|
VISUALIZATION OF CHOROIDAL NEOVASCULARIZATION USING TWO COMMERCIALLY AVAILABLE SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY DEVICES. Retina 2020; 39:1682-1692. [PMID: 30074522 DOI: 10.1097/iae.0000000000002241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To compare the sensitivity of detection and the measured size of choroidal neovascularization (CNV) on two commercially available spectral domain optical coherence tomography angiography (OCTA) devices, the Optovue RTVue XR Avanti with AngioVue and the Zeiss Cirrus HD-OCT with AngioPlex. METHODS Patients with CNV lesions were imaged consecutively on both OCTA devices on the same day of their visit. 3 × 3 mm and 6 × 6 mm scans centered at the fovea were obtained. Two independent masked readers evaluated the OCTA images for CNV identification and its area measurements. RESULTS No significant differences were observed between the 2 OCTA devices in CNV area measurements on their 3 × 3 mm and 6 × 6 mm scans. However, there was suboptimal performance of their automated segmentation algorithms as compared to manually adjusted segmentation for visualizing CNV lesions. CONCLUSION There was no significant difference in the size of the CNV lesion as measured on either commercially available spectral domain OCTA device. Both devices were comparable in their detection of CNV lesions on manual adjustment of segmentation lines. However, their automated segmentation algorithms need improvement to allow for accurate measurement of CNV lesions for routine clinical application.
Collapse
|
11
|
Ozdemir Zeydanli E, Gurelik G. Optical coherence tomography angiography markers associated with treatment response in neovascular age-related macular degeneration. Eur J Ophthalmol 2020; 31:1192-1200. [PMID: 32450717 DOI: 10.1177/1120672120925790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To investigate whether qualitative and quantitative features of choroidal neovascular membranes are associated with anti-vascular endothelial growth factor treatment response in patients with neovascular age-related macular degeneration. METHODS A total of 41 eyes were included in this cross-sectional observational study and divided into "good responders" and "poor responders" based on the long-term functional changes, frequency of recurrent choroidal neovascular activity, and injection need. Enface optical coherence tomography angiography images were obtained and qualitative features of choroidal neovascular membranes were described based on vessel network density. Then, quantitative measurements including vessel area, vessel length, junction density, and lacunarity were calculated using validated software (ImageJ and AngioTool). Chi-square tests, t-test, or Mann-Whitney U tests were used for group comparisons, and intraclass correlation coefficients were calculated for reliability assessment of quantitative analyses. RESULTS Twenty-two eyes treated by a median of 9 (3-24) anti-vascular endothelial growth factor injections at a median follow-up of 41 (12-89) months were categorized as good responders, 19 treated by a median of 26 (11-46) injections at a median follow-up of 44.5 (12-84) months as poor responders. Good responder group mostly had loose network (45.5%), and poor responders mostly had dense network (47.7%). The difference was not statistically significant (p = 0.25). The size of the lesion was 2.7 times greater at baseline (p = 0.04) and 1.7 times greater at final examination in the poor responder group (p = 0.04). Lacunarity index, showing lesion heterogeneity, was higher in good responders (p = 0.018) than poor responders. Other quantitative vascular features did not significantly differ between the groups (p > 0.05). CONCLUSION Long-term remodeling of chronically treated choroidal neovascular may be non-invasively and reproducibly investigated using optical coherence tomography angiography. Quantitative analysis and lacunarity index, in particular, may be used as a measure of vessel maturation and guide treatment strategies in neovascular age-related macular degeneration.
Collapse
|
12
|
Tang W, Guo J, Liu W, Xu G. Optical Coherence Tomography Angiography of Inflammatory Choroidal Neovascularization Early Response after Anti-VEGF Treatment. Curr Eye Res 2020; 45:1556-1562. [PMID: 32394732 DOI: 10.1080/02713683.2020.1767790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Wenyi Tang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Jingli Guo
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Wei Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China
| |
Collapse
|
13
|
Optic Coherence Tomography Angiography Findings of Bilateral Choroidal Neovascularization Associated with Optic Disc Drusen Treated with Intravitreal Aflibercept Injection. Case Rep Ophthalmol Med 2020; 2020:8398054. [PMID: 32231830 PMCID: PMC7085837 DOI: 10.1155/2020/8398054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/20/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this case report is to present the findings of optical coherence tomography angiography (OCTA) of a patient with bilateral choroidal neovascularization (CNV) associated with optic disc drusen (ODD), who was treated with intravitreal aflibercept injection. Case presentation. A 14-year-old girl presented with a complaint of visual loss and metamorphopsia in her both eyes. Best-corrected visual acuity (BCVA) was 20/32 and 20/25, respectively, in the right and left eyes. Intraocular pressure and anterior segment examination were normal. Dilated fundus examination revealed elevated optic discs with blurred margins in both eyes. In addition, slightly elevated yellow lesion extending from optic nerve head to the macula was observed bilaterally. The patient underwent imaging with colour fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), spectral-domain optic coherence tomography (SD-OCT), OCTA, orbital ultrasonography (USG), and computed tomography (CT). In particular, OCTA demonstrated clearly the large circular CNV complex in the right eye and the CNV structure in the left eye containing slightly activated main trunk and minimal vessel loops in the papillomacular region. CNV secondary to bilateral ODD was suspected. Intravitreal aflibercept injections were performed in 3 doses to the right eye and a single dose to the left eye. After the injections, BCVA reached its complete level in both eyes. SD-OCT revealed irregularity of RPE in the temporal region of the optic disc and complete regression of the subretinal fluid. Interestingly, the entire CNV complex including the main trunk completely disappeared in OCTA. CNV complex was not observed in OCTA during 1-year follow-up, and peripapillary and macular vascular density measurements did not show any significant change. BCVA was preserved, and no additional injections were needed. Conclusion It is possible that OCTA can be used for detailed evaluation of CNV associated with ODD, response to anti-VEGF treatment, and peripapillary and macular vascular density. There is a need for further studies to confirm the changes such as disappearance of CNV in OCTA after injection as we observed in our patient.
Collapse
|
14
|
SWEPT-SOURCE AND SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY VERSUS DYE ANGIOGRAPHY IN THE MEASUREMENT OF TYPE 1 NEOVASCULARIZATION. Retina 2020; 40:499-506. [DOI: 10.1097/iae.0000000000002452] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY, FLUORESCEIN ANGIOGRAPHY, AND INDOCYANINE GREEN ANGIOGRAPHY COMPARISONS REVISITED. Retina 2019; 40:2010-2017. [DOI: 10.1097/iae.0000000000002695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
16
|
Kim JM, Cho HJ, Kim Y, Jung SH, Lee DW, Kim JW. Responses of Types 1 and 2 Neovascularization in Age-Related Macular Degeneration to Anti-Vascular Endothelial Growth Factor Treatment: Optical Coherence Tomography Angiography Analysis. Semin Ophthalmol 2019; 34:168-176. [PMID: 31132283 DOI: 10.1080/08820538.2019.1620791] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To compare the responses of types 1 (sub-pigment epithelial) and 2 (subretinal) neovascularization in neovascular age-related macular degeneration (AMD) to anti-vascular endothelial growth factor (VEGF) treatment. Methods: Fifty-five treatment-naïve neovascular AMD eyes (53 patients) were retrospectively included for analysis. All patients were treated with three loading injections of anti-VEGF agent, followed by further injections as required. The lesion size and vascular density of type 1 and 2 lesions before and after treatment for 12 months were analyzed using optical coherence tomography angiography (OCTA). Results: The mean lesion size of the type 1 neovascularization group (42 eyes) showed no significant change from 2.12 ± 1.01 mm2 at baseline to 2.08 ± 0.91 mm2 at 12 months (P = .682). However, the mean lesion size of type 2 neovascularization significantly decreased from 1.23 ± 0.93 mm2 at baseline to 0.79 ± 0.61 mm2 at 12 months (P = .022). The proportion of eyes with lesion sizes that decreased by more than 40% from baseline was also significantly higher for the type 2 compared to the type 1 neovascularization group (46.2% versus 11.9%, P = .007). Vascular density showed no significant changes for both groups after treatment and showed no association with the change in lesion size. There was no significant difference between the groups in terms of visual acuity improvement. Conclusion: OCTA analysis revealed different responses to anti-VEGF treatment depending on the location of neovascularization in neovascular AMD. Type 2 neovascularization was significantly regressed compared to type 1 neovascularization after anti-VEGF treatment. However, the changes in vascular density and visual outcome showed no significant differences between groups after 12 months of treatment.
Collapse
Affiliation(s)
- Jae Min Kim
- a Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute , Konyang University College of Medicine , Seoul , South Korea
| | - Han Joo Cho
- a Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute , Konyang University College of Medicine , Seoul , South Korea
| | - Yeji Kim
- a Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute , Konyang University College of Medicine , Seoul , South Korea
| | - Seoung Heon Jung
- a Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute , Konyang University College of Medicine , Seoul , South Korea
| | - Dong Won Lee
- a Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute , Konyang University College of Medicine , Seoul , South Korea
| | - Jong Woo Kim
- a Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute , Konyang University College of Medicine , Seoul , South Korea
| |
Collapse
|
17
|
VASCULAR REMODELING OF CHOROIDAL NEOVASCULARIZATION AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY VISUALIZED ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2019; 39:548-557. [DOI: 10.1097/iae.0000000000001964] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
Roberts PK, Zotter S, Montuoro A, Pircher M, Baumann B, Ritter M, Hitzenberger CK, Schmidt-Erfurth U. Identification and Quantification of the Angiofibrotic Switch in Neovascular AMD. ACTA ACUST UNITED AC 2019; 60:304-311. [DOI: 10.1167/iovs.18-25189] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Philipp K. Roberts
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria
| | - Stefan Zotter
- Center for Medical Physics and Biomedical Engineering of the Medical University of Vienna, Vienna, Austria
| | - Alessio Montuoro
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria
| | - Michael Pircher
- Center for Medical Physics and Biomedical Engineering of the Medical University of Vienna, Vienna, Austria
| | - Bernhard Baumann
- Center for Medical Physics and Biomedical Engineering of the Medical University of Vienna, Vienna, Austria
| | - Markus Ritter
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria
| | - Christoph K. Hitzenberger
- Center for Medical Physics and Biomedical Engineering of the Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria
| |
Collapse
|
19
|
Rispoli M, Savastano MC, Lumbroso B. Quantitative Vascular Density Changes in Choriocapillaris Around CNV After Anti-VEGF Treatment: Dark Halo. Ophthalmic Surg Lasers Imaging Retina 2018; 49:918-924. [DOI: 10.3928/23258160-20181203-02] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/15/2018] [Indexed: 02/04/2023]
|
20
|
McClintic SM, Gao S, Wang J, Hagag A, Lauer AK, Flaxel CJ, Bhavsar K, Hwang TS, Huang D, Jia Y, Bailey ST. Quantitative Evaluation of Choroidal Neovascularization under Pro Re Nata Anti-Vascular Endothelial Growth Factor Therapy with OCT Angiography. Ophthalmol Retina 2018; 2:931-941. [PMID: 30238069 PMCID: PMC6139650 DOI: 10.1016/j.oret.2018.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To use optical coherence tomography angiography (OCTA) derived quantitative metrics to assess the response of choroidal neovascularization to pro-re-nata (PRN) anti-endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (AMD). DESIGN Prospective longitudinal cohort study. PARTICIPANTS Fourteen eyes from 14 study participants with treatment-naïve neovascular AMD were enrolled. METHODS Subjects were evaluated monthly and treated with intravitreal anti-VEGF agents under a PRN protocol for one year. At each visit, two 3×3 mm2 OCTA scans were obtained. Custom image processing was applied to segment the outer retinal slab, suppress projection artifact, and automatically detect CNV. CNV membrane area (mm2) and CNV vessel area (mm2) was calculated. MAIN OUTCOMES Individual and mean CNV membrane area and CNV vessel area at each visit; within-visit repeatability determined by coefficient of variation. RESULTS Eight eyes had entire CNV within 3×3 mm2 scanning area and had adequate image quality for CNV quantification. One case (case #2) was excluded from analysis due to the presence of a large subretinal hemorrhage overlying the CNV membrane. In the remaining cases, CNV vessel area was reduced by 39%, 50%, 43%, and 41% at months 1, 3, 6, and 12 respectively. CNV membrane area was reduced by 39%, 51%, 54%, and 45% at months 1, 3, 6, and 12. At month 6, mean change from baseline was not statistically significant for CNV vessel area, while it was statistically significant for CNV membrane area. Neither metric was significantly different compared to baseline at month 12. Individual analyses revealed each CNV had a unique response under PRN treatment. Within-visit repeatability was was 7.96% (coefficient of variation) for CNV vessel area and 7.37% for CNV membrane area. CONCLUSIONS In this small exploratory study of CNV response to PRN anti-VEGF treatment, both CNV vessel area and membrane area were reduced compared to baseline after three months. After one year of follow-up, these reductions were no longer statistically significant. When anti-VEGF treatment was held, increasing CNV vessel area over time often resulted in exudation, but it was not possible to exactly when exudation occurs.
Collapse
Affiliation(s)
- Scott M McClintic
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Simon Gao
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ahmed Hagag
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andreas K Lauer
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Christina J Flaxel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Kavita Bhavsar
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| |
Collapse
|
21
|
Aflibercept Treatment Leads to Vascular Abnormalization of the Choroidal Neovascularization. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:8595278. [PMID: 29850003 PMCID: PMC5925136 DOI: 10.1155/2018/8595278] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/13/2018] [Indexed: 01/10/2023]
Abstract
Recent studies do not support the hypothesis of vascular normalization in the eyes receiving various types of intravitreous antivascular endothelial growth factor (VEGF). This retrospective study considered 57 eyes of 32 patients with vascular age-related macular degeneration (AMD) undergoing aflibercept treatment. In this study, we measured the vessel density, Horton-Strahler (HS) ramification ratio (complexity), and the length ratio in 14 eyes with choroidal neovascularization treated with 3–5 Eylea injections, 17 eyes receiving 1-2 injections, and 14 treatment-naïve eyes to the use of swept source optical coherence tomography angiography (OCTA). Macular 6 × 6 mm scans were acquired using the DRI OCT Triton by a single trained technician. OCTA images were standardized, binarized, and skeletonized using ImageJ. Then, the HS analysis of the CNV was performed. Our data suggest that the vascular density significantly decreases after an anti-VEGF injection 36 and 93 versus 41 and 87 in treatment-naïve patients. Moreover, CNV before the treatment and in a group with 3–5 injections was more complex than after receiving 1-2 injections. The branch length was not changed. Repeated anti-VEGF can lead to vascular abnormalization and further research is needed to confirm the results of this study.
Collapse
|
22
|
Cohen SY, Miere A, Nghiem-Buffet S, Fajnkuchen F, Souied EH, Mrejen S. Clinical applications of optical coherence tomography angiography: What we have learnt in the first 3 years. Eur J Ophthalmol 2018; 28:491-502. [PMID: 29554812 DOI: 10.1177/1120672117753704] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A review of the literature from 2014 to 2016 was conducted, focusing on the results of optical coherence tomography angiography in different chorioretinal diseases. In only 3 years, optical coherence tomography angiography has been shown to be an effective tool for diagnosing choroidal neovascularization complicating age-related macular degeneration, pathologic myopia, and inflammatory conditions. The technique has sometimes been considered superior to conventional multimodal imaging, for example, in choroidal neovascularization associated with chronic central serous chorioretinopathy or multifocal choroiditis. In retinal vascular diseases, optical coherence tomography angiography has helped to understand the condition described as paracentral acute middle maculopathy and has been considered highly effective for the analysis of retinal vascular macular changes secondary to retinal vein occlusion or macular telangiectasia. Changes in the foveal avascular zone, also reported in diabetic maculopathy, have been shown to occur before any angiographic signs. A reduction in capillary vascular density has been reported in the fovea of eyes with malignant melanoma, but not in eyes with choroidal nevus. However, optical coherence tomography angiography is a recent technique that probably needs refinements and further studies. Nevertheless, the first 3 years of optical coherence tomography angiography use suggest its clinical relevance and useful applications in daily clinical practice.
Collapse
Affiliation(s)
- Salomon Y Cohen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France.,2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Alexandra Miere
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | | | | | - Eric H Souied
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Sarah Mrejen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France
| |
Collapse
|
23
|
Anegondi N, Chidambara L, Bhanushali D, Gadde SGK, Yadav NK, Sinha Roy A. An automated framework to quantify areas of regional ischemia in retinal vascular diseases with OCT angiography. JOURNAL OF BIOPHOTONICS 2018; 11:e201600312. [PMID: 28700136 DOI: 10.1002/jbio.201600312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Abstract
In this observational and cross-sectional study, capillary nonperfusion (CNP) and vascular changes in branch retinal vein occlusion (BRVO, sample size [n] = 26) and choroidal neovascularization (CNV, n = 29) were evaluated. Subjects underwent imaging using Optical coherence tomography angiography (Angiovue OCTA, RTVue XR, Optovue Inc., Fremont, California). Local fractal analysis was applied to the OCTA images of superficial, deep and choriocapillaris layer. CNP area (BRVO eyes) and vascular parameters were computed using local fractal-based method. Sensitivity and specificity of vascular parameters were assessed with receiver operating characteristics curve. Automated CNP area showed excellent agreement with manually quantified CNP areas in both superficial (intraclass coefficient [ICC] = 0.96) and deep (ICC = 0.96) layers. BRVO eyes showed significantly altered (P < .05) vascular parameters in both superficial and deep layer as compared to normal eyes (n = 30). CNVM eyes had significantly higher capillary free zones (P < .001) as compared to normal eyes. In normal vs BRVO eyes, vessel density and spacing between the large vessels had similar area under the curve (AUC) (P > .05) in both superficial (0.97 and 0.97, respectively) and deep layer (0.99 and 0.98, respectively). Further, capillary free zones showed high AUC (0.92) in differentiating CNV eyes from normal eyes.
Collapse
Affiliation(s)
- Neha Anegondi
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bangalore, India
| | | | | | | | - Naresh K Yadav
- Retina Department, Narayana Nethralaya, Bangalore, India
| | - Abhijit Sinha Roy
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bangalore, India
| |
Collapse
|
24
|
Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G. Optical coherence tomography angiography. Prog Retin Eye Res 2017; 64:1-55. [PMID: 29229445 PMCID: PMC6404988 DOI: 10.1016/j.preteyeres.2017.11.003] [Citation(s) in RCA: 954] [Impact Index Per Article: 136.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 02/07/2023]
Abstract
Optical coherence tomography (OCT) was one of the biggest advances in ophthalmic imaging. Building on that platform, OCT angiography (OCTA) provides depth resolved images of blood flow in the retina and choroid with levels of detail far exceeding that obtained with older forms of imaging. This new modality is challenging because of the need for new equipment and processing techniques, current limitations of imaging capability, and rapid advancements in both imaging and in our understanding of the imaging and applicable pathophysiology of the retina and choroid. These factors lead to a steep learning curve, even for those with a working understanding dye-based ocular angiography. All for a method of imaging that is a little more than 10 years old. This review begins with a historical account of the development of OCTA, and the methods used in OCTA, including signal processing, image generation, and display techniques. This forms the basis to understand what OCTA images show as well as how image artifacts arise. The anatomy and imaging of specific vascular layers of the eye are reviewed. The integration of OCTA in multimodal imaging in the evaluation of retinal vascular occlusive diseases, diabetic retinopathy, uveitis, inherited diseases, age-related macular degeneration, and disorders of the optic nerve is presented. OCTA is an exciting, disruptive technology. Its use is rapidly expanding in clinical practice as well as for research into the pathophysiology of diseases of the posterior pole.
Collapse
Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, United States.
| | - James G Fujimoto
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA, United States
| | - Nadia K Waheed
- The Department of Ophthalmology, Tufts University School of Medicine, Boston MA, United States
| | - Srinivas R Sadda
- Doheny Eye Institute, University of California - Los Angeles, Los Angeles, CA, United States
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| |
Collapse
|
25
|
Munk MR, Giannakaki-Zimmermann H, Berger L, Huf W, Ebneter A, Wolf S, Zinkernagel MS. OCT-angiography: A qualitative and quantitative comparison of 4 OCT-A devices. PLoS One 2017; 12:e0177059. [PMID: 28489918 PMCID: PMC5425250 DOI: 10.1371/journal.pone.0177059] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/23/2017] [Indexed: 01/09/2023] Open
Abstract
Purpose To compare the quality of four OCT-angiography(OCT-A) modules. Method The retina of nineteen healthy volunteers were scanned with four OCT-devices (Topcon DRI-OCT Triton Swept-source OCT, Optovue RTVue-XR, a prototype Spectralis OCT2, Heidelberg-Engineering and Zeiss Cirrus 5000-HD-OCT). The device-software generated en-face OCT-A images of the superficial (SCP) and deep capillary plexuses (DCP) were evaluated and scored by 3 independent retinal imaging experts. The SCP vessel density was assessed using Angiotool-software. After the inter-grader reliability assessment, a consensus grading was performed and the modules were ranked based on their scoring. Results There was no significant difference in the vessel density among the modules (Zeiss 48.7±4%, Optovue 47.9±3%, Topcon 48.3±2%, Heidelberg 46.5±4%, p = 0.2). The numbers of discernible vessel-bifurcations differed significantly on each module (Zeiss 2±0.9 bifurcations, Optovue 2.5±1.2, Topcon 1.3±0.7 and Heidelberg 0.5±0.6, p≤0.001). The ranking of each module differed depending on the evaluated parameter. In the overall ranking, the Zeiss module was superior and in 90% better than the median (Bonferroni corrected p-value = 0.04). Optovue was better than the median in 60%, Topcon in 40% and Heidelberg module in 10%, however these differences were not statistically significant. Conclusion Each of the four evaluated OCT-A modules had particular strengths, which differentiated it from their competitors.
Collapse
Affiliation(s)
- Marion R. Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Bern Photographic Reading Center, University of Bern, Switzerland
- * E-mail:
| | - Helena Giannakaki-Zimmermann
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Bern Photographic Reading Center, University of Bern, Switzerland
| | - Lieselotte Berger
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Clinical Research, Inselspital Bern University Hospital, University of Bern, Switzerland
| | - Wolfgang Huf
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Andreas Ebneter
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Clinical Research, Inselspital Bern University Hospital, University of Bern, Switzerland
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Bern Photographic Reading Center, University of Bern, Switzerland
- Department of Clinical Research, Inselspital Bern University Hospital, University of Bern, Switzerland
| | - Martin S. Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Bern Photographic Reading Center, University of Bern, Switzerland
- Department of Clinical Research, Inselspital Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|
26
|
Optical Coherence Tomography Angiography to Estimate Retinal Blood Flow in Eyes with Retinitis Pigmentosa. Sci Rep 2017; 7:46396. [PMID: 28406171 PMCID: PMC5390317 DOI: 10.1038/srep46396] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 03/15/2017] [Indexed: 12/05/2022] Open
Abstract
Ophthalmologists sometimes face difficulties in identifying the origin of visual acuity (VA) loss in a retinitis pigmentosa (RP) patient, particularly before cataract surgery: cataract or the retinal disease state. Therefore, it is important to identify the significant factors correlating with VA. Nowadays, retinal blood flow in superficial and deep layers can be estimated non-invasively using optical coherence tomography angiography (OCTA). We estimated blood flow per retinal layer by using OCTA; investigated the correlation between VA and other parameters including blood flow and retinal thickness; and identified the most associated factor with VA in patients with RP. OCTA images in 68 of consecutive 110 Japanese RP patients were analysable (analysable RP group). Thirty-two age- and axial length-matched healthy eyes (control group) were studied. In the analysable RP group, the parafoveal flow density in superficial and deep layers was 47.0 ± 4.9% and 52.4 ± 5.5%, respectively, which was significantly lower than that in controls. Using multivariate analysis, we found that the parafoveal flow density in the deep layer and superficial foveal avascular area were the factors associated with VA. Non-invasive estimation of retinal blood flow per retinal layer using OCTA is useful for predicting VA in RP patients.
Collapse
|
27
|
The Application of OCTA in Assessment of Anti-VEGF Therapy for Idiopathic Choroidal Neovascularization. J Ophthalmol 2016; 2016:5608250. [PMID: 27471600 PMCID: PMC4947658 DOI: 10.1155/2016/5608250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/09/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess the morphology of idiopathic choroidal neovascularization (ICNV) by optical coherence tomography angiography (OCTA) and determine the therapeutic effects of intravitreal antivascular endothelial growth factor (anti-VEGF). Method. Patients with naive ICNV were assessed by spectral domain optical coherence tomography (SD-OCT) and OCTA in this observational study. The timing of observation was before treatment, 1 day after treatment with intravitreal anti-VEGF injection, and 1 month after the treatment. The central retina thickness (CRT) on SD-OCT, selected CNV area, and flow area on OCTA were measured. Results. A total of 17 eyes from 17 patients with ICNV were included in this study. OCTA showed visible irregular choroidal neovascularization with "tree-in-bud" form on outer retinal layer. After treatment, as well as in the 1-day follow-up, CNV decreased in size from the periphery, and the vessel density was reduced. As shown on OCTA, the selected CNV area and flow area were significantly reduced compared to pretreatment. The rate of CNV vessel area changes was higher on OCTA than the changes in CRT on SD-OCT at 1-day and 1-month follow-up. Conclusion. Intravitreal injection of anti-VEGF is effective for idiopathic choroidal neovascularization, and the treatment outcomes are observable after 1 day. OCTA provides a useful approach for monitoring and evaluating the treatment of intravitreal anti-VEGF for CNV.
Collapse
|
28
|
De Vitis LA, Benatti L, Tomasso L, Baldin G, Carnevali A, Querques L, Querques G, Bandello F. Comparison of the Performance of Two Different Spectral-Domain Optical Coherence Tomography Angiography Devices in Clinical Practice. Ophthalmic Res 2016; 56:155-62. [DOI: 10.1159/000447094] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
|