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
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: 381 392.
Parafoveal capillary network in diabetes
Capillary non-perfusion in BRVO
Myopic Choroidal Neovascularization
Focal leak in central serous chorioretinopathy
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;81:428-30. Ha SO, et al. Anaphylaxis caused by intravenous fluorescein: clinical characteristics and review of literature. Intern Emerg Med 2014;9:325-30.
OCT is a not invasive technique able to study several vitreous-retinal-choroidal disease Huang D, et al. Optical coherence tomography. Science 1991;254:1178-81.
OCT procedures surpassed the sum of other ophthalmic imaging procedures OCT Fundus photography Fluorescein Angiography Swanson E and Huang D, 2011
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
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.
vascular segmentation
Vascular segmentation Avascular zone: noise reduction on/off
Vascular segmentation Choroid (myopia)
Type 1 CNV
Type 2 CNV
Type 3 NV
Myopic CNV
Filamentous CNV
Flow: area quantification and follow up
Non-flow: area quantification and follow up
Flow density map
Flow density map in diabetic retinopathy
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
Apr 14 2014 Oct 15 2015
Time progress
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
Will OCT Angiography Replace Fluorescein Angiography? * *Bruno Lumbroso MD
Probably YES FA OCT-A
OCT-A identifies more about the FAZ than conventional FA OCT-A FA
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]
FA and OCT-A images of microaneurysms did not agree completely Because all microaneourysms are at different depht of planes of the retina
Some microaneurysms probably show low flow Courtesy of Bruno Lumbroso MD
FA and OCT-A show non flow areas of capillary nonperfusion
OCT-A reveals did not reveal choriocapillaris RPE focal hyperpermeability leak point in CSC
Limit: Field of view 92416 pixel (XR) 65536 pixel (other commercial devices) 3x3 mm 6x6 mm 8x8 mm Di Antonio s Eye Undilated
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
Thank you