Will OCT-Angiography replace FA?

Transcription

1 ASL Roma A PRESIDIO TERRITORIALE NUOVO REGINA MARGHERITA AMBULATORIO PATOLOGIE RETINICHE Resp. Dott.ssa SUSANNA CATALANO CENTRO ITALIANO MACULA Will OCT-Angiography replace FA? Marco Rispoli, Luca di Antonio, Bruno Lumbroso

2 FA is the gold standard for the diagnosis and treatment of retinovascular disease: Diabetic retinopathy (DR) Retinal vein occlusion (RVO) Aged macular degeneration (AMD) etc. Leila Laatikainen. The fluorescein angiography revolution: a breakthrough with sustained impact Acta Ophthalmol. Scand. 2004: 82:

3 Parafoveal capillary network in diabetes

4 Capillary non-perfusion in BRVO

5 Myopic Choroidal Neovascularization

6 Focal leak in central serous chorioretinopathy

7 FA requires intravenous dye injection, which can result in: hypotension nausea vomiting rarely anaphylaxis (0.083 %) Lopez-Saez MP, et al. Fluorescein induced allergic reaction. Ann Allergy Asthma Immunol 1998;81: Ha SO, et al. Anaphylaxis caused by intravenous fluorescein: clinical characteristics and review of literature. Intern Emerg Med 2014;9:

8 OCT is a not invasive technique able to study several vitreous-retinal-choroidal disease Huang D, et al. Optical coherence tomography. Science 1991;254:

9 OCT procedures surpassed the sum of other ophthalmic imaging procedures OCT Fundus photography Fluorescein Angiography Swanson E and Huang D, 2011

10 Motion Contrast is measured by the decorrelation signal 2 repeat OCT frames Can generate 11 decorrelation sets by splitting the OCT spectrum Allowing to build a 304 x 304 Angio-OCT volume in only 3 secs by performing repeated B-scan located at the same retinal location

11 OCT-A introduced new concepts: - Vascular segmentation - Flow It is absolutely not possible to define hyper or hypo reflectivity in OCT -A, these terms are related to the structural OCT and are not absolutely comparable to the flow signals, which are described with other terminology: Hyper/hypo-density (high/low-flow) Lumbroso B, et al. Clinical Guide to Angio-OCT Non Invasive Dyeless OCT Angiography. Jaypee Brothers Medical Publisher (P) Ltd. New Delhi, India, 2015.

12 vascular segmentation

13 Vascular segmentation Avascular zone: noise reduction on/off

14 Vascular segmentation Choroid (myopia)

15 Type 1 CNV

16 Type 2 CNV

17 Type 3 NV

18 Myopic CNV

19 Filamentous CNV

20 Flow: area quantification and follow up

21 Non-flow: area quantification and follow up

22 Flow density map

23 Flow density map in diabetic retinopathy

24 Clinical case: follow up qualitative and quantitative analysis Female 62 yo Refraction +2sf VA 0,2 (20/100) CNV type mixed (1/2) Follow up 18 months

25 Apr Oct

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27 Time progress

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29 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 vessel area 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 VA 0 2/3/14 10/6/14 18/9/14 27/12/14 6/4/15 15/7/15 23/10/15 31/1/16 0 2/3/14 10/6/14 18/9/14 27/12/14 6/4/15 15/7/15 23/10/15 31/1/16

30 Will OCT Angiography Replace Fluorescein Angiography? * *Bruno Lumbroso MD

31 Probably YES FA OCT-A

32 OCT-A identifies more about the FAZ than conventional FA OCT-A FA

33 Interconnection between the vascular plexuses superficial interconnession deep Savastano MC et al. In vivo characterization of retinal vascularization morphology using optical coherence tomography angiography. Retina 2015 [Epub ahead of print]

34 FA and OCT-A images of microaneurysms did not agree completely Because all microaneourysms are at different depht of planes of the retina

35 Some microaneurysms probably show low flow Courtesy of Bruno Lumbroso MD

36 FA and OCT-A show non flow areas of capillary nonperfusion

37 OCT-A reveals did not reveal choriocapillaris RPE focal hyperpermeability leak point in CSC

38 Limit: Field of view pixel (XR) pixel (other commercial devices) 3x3 mm 6x6 mm 8x8 mm Di Antonio s Eye Undilated

39 Conclusions FA remains the gold standard method to assess retinal microcirculation, but requires intravenous dye injection OCT-A is a non invasive technique able to reveal more about the retinal microvasculature than conventional FA: Vascular plexuses Flow, non-flow, Vessel density map New vessels Blood Flow Study (in the near future) There is not leakage, pooling or staining

40 Thank you