ANGIO OCT IMAGING OF MACULAR VASCULATURE IN DIABETIC MACULAR EDEMA BEFORE AND AFTER MACULAR SURGERY

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1 17th EVRS Meeting September 14-17, 2017 Teatro della Pergola FLORENCE - ITALY ANGIO OCT IMAGING OF MACULAR VASCULATURE IN DIABETIC MACULAR EDEMA BEFORE AND AFTER MACULAR SURGERY G. Macrì, G. Pacelli, V. Belloli Ospedale SS. Trinità Borgomanero-Arona (NO), Italy

2 17th EVRS Meeting September 14-17, 2017 Teatro della Pergola FLORENCE - ITALY PURPOSE: TO DETERMINE THE SIZE OF FOVEAL AVASCULAR ZONE (FAZ) AND OF SUPEROTEMPORAL PARAFOVEAL ISCHEMIC ZONE BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY (OCTA) BEFORE AND AFTER SURGERY FOR A SINGLE CASE OF TRACTIONAL DIABETIC MACULAR EDEMA. METHODS: PARS PLANA VITRECTOMY (25 GAUGE) WAS PERFORMED WITH ILM-PEELING. THE SUPERFICIAL PLEXUS WAS ANALYZED BY OCTA IN 4,5x4,5MM CENTRAL MACULA REGION. THE TWO AVASCULAR AREAS WERE MEASURED BEFORE AND AT 1 AND 3 MONTHS AFTER SURGERY USING A MANUAL TRACING TOOL. THE CENTRAL MACULAR THICKNESS (CMT) WAS MEASURED TO DETERMINE THE EFFICACY OF OUR SURGICAL PROCEDURE.

3 17th EVRS Meeting - September 14-17, Teatro della Pergola, FLORENCE - ITALY PREOPERATIVE FINDINGS CS, 74 year- old man suffering from diabetes mellitus with chronic tractional diabetic macular edema (T-DME); pseudophakic. Comorbidity: systemic hypertension. BCVA (Snellen): 1/10 Angiography (HRA Spectralis): irregular fluorescein leakage. OCT (HRA Spectralis): cystoid macular edema (central average thickness: 534 micron); epiretinal membrane. OCTA (Topcon): foveal avascular zone (FAZ: 219,9 µm²) and superotemporal parafoveal ischemic zone.

4 17th EVRS Meeting - September 14-17, Teatro della Pergola, FLORENCE - ITALY 1 MONTH POSTOPERATIVE FINDINGS BCVA (Snellen): 3/10 OCT (HRA Spectralis): reduction of macular edema (central average thickness: 460 micron); absence of residual epiretinal membrane. Partial reduction of cysts. OCTA (Topcon): reduction of foveal avascular zone (FAZ: 95,9 µm²) and unchanged superotemporal parafoveal ischemic zone.

5 17th EVRS Meeting - September 14-17, Teatro della Pergola, FLORENCE - ITALY 3 MONTH POSTOPERATIVE FINDINGS BCVA (Snellen): 3/10 Angiography (HRA Spectralis): significant reduction of fluorescein leakage. OCT (HRA Spectralis): further reduction of macular edema (central average thickness: 422 micron); absence of residual epiretinal membrane. Further reduction of cysts. OCTA (Topcon): further reduction of foveal avascular zone (FAZ: 31,8 µm²) and unchanged superotemporal parafoveal ischemic zone.

6 17th EVRS Meeting - September 14-17, Teatro della Pergola, FLORENCE - ITALY RESULTS: THE AREA OF FAZ AND THE CMT WERE REDUCED POSTOPERATIVELY. THE SUPEROTEMPORAL PARAFOVEAL ISCHEMIC ZONE REMAINED UNCHANGED. CONCLUSIONS: OCTA AFTER MACULAR SURGERY SHOW A DECREASE OF FAZ AND OF CMT IN ABSENCE OF ANY SURGICAL DAMAGE. WE ALSO THINK THAT THIS RESULT COULD BE INFLUENCED BY THE REGRESSION OF PARAFOVEAL CYSTS WITH A DECOMPRESSION ON THE FOVEAL CAPILLARY PLEXUS. HOWEVER, LARGER STUDIES ARE NEEDED TO CONFIRM THESE RESULTS AND TO EVALUATE THE REPRODUCIBILITY OF THE MANUAL MEASURING TECHNIQUE. PREOPERATIVE 3 MONTH POSTOP. PREOPERATIVE 1 MONTH POSTOP. CHANGE 3 MONTH POSTOP.

7 G. Macrì, G. Pacelli, V. Belloli Ospedale SS. Trinità Borgomanero-Arona (NO), Italy 17th EVRS Meeting September 14-17, 2017 Teatro della Pergola FLORENCE - ITALY ANGIO OCT IMAGING OF MACULAR VASCULATURE IN DIABETIC MACULAR EDEMA BEFORE AND AFTER MACULAR SURGERY REFERENCES 1. Samara WA, Say EA, Khoo CT, Higgins TP, Mgrath G, Ferenczy S, Shields CL. CORRELATION OF FOVEAL AVASCULAR ZONE SIZE WITH FOVEAL MORPHOLOGY IN NORMAL EYES USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2015 Nov;35(11): Lee J, Rosen R. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN DIABETES. Curr Diab Rep Dec; 16(12): Koulisis N, Kim AY, Chu Z, Shahidzadeh A, Burkemper B, Olmos de Kos L, Moshfedhi AA, Ameri H, Puliafito CA, Isozakj VL, Wang RK, Kashani AH. QUANTITATIVE MICROVASCULAR ANALYSIS OF RETINAL VENOUS OCCLUSIONS BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Plos One. 2017; 12(4) 4. Baba T, Kakisu M, Nizawa T, Oshitari T, Yamamoto S. SUPERFICIAL FOVEAL AVASCULAR ZONE DETERMINED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BEFORE AND AFTER MACULAR HOLE SURGERY. Retina Mar; 37(3): Kwon J, Choi J, Shin JW, Lee J, Kook MS. ALTERATIONS OF THE AVASCULAR ZONE MEASURED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN GLAUCOMA PATIENTS WITH CENTRL VISUAL FIELD DEFECTS. Invest Ophthalmol Vis Sci Mar 1;58(3): Sambhav K, Abu-Amero KK, Chalam KV. Eur. J. DEEP CAPILLARY MACULAR PERFUSION INDICES OBTAINED WITH OCT ANGIOGRAPHY CORRELATE WITH DEGREE OF NONPROLIFERATIVE DIABETIC RETINOPATHY. Ophthalmol Mar 27:0 7. Gill A, Cole ED, Novais EA, Louzada RN, De Carlo T, Duker JS, Waheed NK, Baumal CR, Witkin AJ. VISUALIZATION OF CHANGES IN THE FOVEAL AVASCULAR ZONE IN BOTH OBSERVED AND TREATED DIABETIC MACULA EDEMA USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Int J retina Vitreous Jun 19,3:19 8. Sambhav K, Grover S, Chalam KV. THE APPLICATION OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN RETINAL DISEASES. Surv Ophthalmol Jun