Progression of vascular changes in macular telangiectasia type 2: comparison between SD-OCT and OCT angiography

Pauleikhoff, Daniel; Gunnemann, Frederic; Book, Marius; Rothaus, Kai

doi:10.1007/s00417-019-04323-0

Cited by 28 publications

(16 citation statements)

References 35 publications

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“…This finding is supported by a recent OCTA-based study using the presence of HF as an identifying feature of neovascularization in MacTel. [20] In line with our findings, this study also found a correlation between progressive vascular abnormalities (culminating with neovascularization as marked by HF) and progressive EZ loss.…”

Section: Discussionsupporting

confidence: 91%

“…[17] These studies suggest a possible causal link between neurodegenerative loss of the photoreceptors and subsequent angiogenesis in the proliferative phase of MacTel, though this relationship has not been explored in human MacTel. EZ loss, a marker of the zone of photoreceptor degeneration, has been shown to be an independent marker of disease severity[18–20] and visual function[21, 22] in MacTel patients. Using OCTA in proliferative MacTel, researchers have shown that the neovascular lesion and the zone of EZ loss show almost complete overlap in eyes with outer retinal neovascularization.…”

Section: Introductionmentioning

confidence: 99%

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Overlap between telangiectasia and photoreceptor loss increases with progression of macular telangiectasia type 2

2019

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ObjectivesTo examine the topographical correlation between ellipsoid zone loss and telangiectasia in the deep capillary plexus in patients with macular telangiectasia type 2 (MacTel).Methods38 eyes (20 subjects) diagnosed with MacTel were imaged with OCTA between March 2016 and June 2019 in this single center, cross-sectional observational study. The en face OCTA and OCT were evaluated for areas of deep capillary plexus telangiectasia and ellipsoid zone loss, respectively, and their outlines were superimposed to study their overlap (mm2). The primary outcome was percentage of overlap and its relationship to MacTel stage. Secondary outcomes included the relationship between neovascularization and hyperreflective foci as well as correlations between ellipsoid zone loss, deep capillary plexus telangiectasia and visual acuity.ResultsIn nonproliferative MacTel stage, ellipsoid zone loss was localized to margins of telangiectatic areas (mean overlap = 15.2%). In proliferative stages, ellipsoid zone loss showed a higher degree of overlap with telangiectatic areas (mean overlap = 62.8%). Overlap increased with advancing MacTel stages, with an overall average of 45.3%. Overlap correlated highly with ellipsoid zone loss (r = 0.831; p<0.0001). Telangiectasia was present in all 38 eyes (range: 0.08mm2–0.99mm2), while ellipsoid zone loss was absent in 6 (range: 0.00–3.32mm2). Visual acuity correlated most strongly with ellipsoid zone loss (r = 0.569; p = 0.0002), followed by overlap (r = 0.544; p = 0.0004), and finally, telangiectasia (r = 0.404; p<0.0118). Presence of hyperreflective foci on OCT correlated with the presence and intraretinal location of neovascularization.ConclusionsEllipsoid zone loss occurs at the margins of deep capillary plexus telangiectasia in nonproliferative MacTel, with progressively increasing overlap as MacTel advances, peaking in proliferative disease. Deep capillary plexus telangiectasia and its overlap with ellipsoid zone loss are two promising markers of nonproliferative MacTel, while hyper-reflective foci are markers for proliferative MacTel.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Overlap between telangiectasia and photoreceptor loss increases with progression of macular telangiectasia type 2

2019

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“…We have already shown in a previous study that the mathematical analyses of ‘skeletonized’ vessels also used in this study are able to quantify the progressive vascular changes in macular telangiectasia type 2 10. This procedure was again used in the present study and showed that the various mathematical characteristics of the vessels may be significantly correlated with the established alterations (fluid distribution on SD-OCT) between inactive and active disease.…”

Section: Discussionsupporting

confidence: 52%

“…Finally, the skeleton pixels are grouped to form smooth vessel segments connected by nodes at bifurcations or crossings. Based on the CNV skeleton and the vascular graph, we computed the aCNV, FD, tlCNV and nsCNV 10…”

Section: Methodsmentioning

confidence: 99%

Changes in the OCT angiographic appearance of type 1 and type 2 CNV in exudative AMD during anti-VEGF treatment

et al. 2019

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ObjectiveOptical coherence tomography angiography (OCT-A) enables detailed visualisation of the vascular structure of choroidal neovascularisation (CNV). The aim of this study was to determine whether mathematically ascertained OCT-A vascular parameters of type 1 and type 2 CNV in exudative age-related macular degeneration (AMD) change during antivascular endothelial growth factor (anti-VEGF) treatment. The OCT-A vascular parameters were also compared with previously obtained activity parameters (fluid distribution on spectral domain OCT (SD-OCT)) to establish whether they could potentially be used as further ‘activity parameters’ for assessment of anti-VEGF treatment.Methods and AnalysisWe evaluated 27 eyes of 27 patients (mean follow-up 9.8 months) with type 1, type 2 or mixed CNV who had received anti-VEGF treatment (IVAN scheme). The parameters analysed were area (aCNV), total length of all vessels (tlCNV), overall number of vascular segments (nsCNV) and fractal dimension (FD) of the CNV. The changes in each of these parameters were correlated with the central foveal thickness (CFT).ResultsRegression and renewed perfusion of the CNV corresponded with the decrease or increase, respectively, of macular fluid distribution on SD-OCT. The increase and decrease of CFT during anti-VEGF treatment were highly significantly correlated with changes in FD (p<0.00001), aCNV (p<0.00001), tlCNV (p<0.00001) and nsCNV (p<0.00001).ConclusionOCT-A enables detailed analysis of AMD with regard to FD, aCNV, tlCNV and nsCNV. As the changes in these parameters correlate closely with changes on SD-OCT, they can be used as new activity parameters, alongside fluid distribution, for assessment of treatment effect and as parameters of stabilisation or the need for repeated treatment.

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“…We showed in a previous study that vessels can be described mathematically and that these parameters also change significantly in the course of anti-VEGF treatment [17,18]. Detection of changes in vessels by OCTA can also make valuable contributions to the diagnosis, monitoring, and prognosis of other vascular disease, such as MacTel type 2 [19] or diabetic retinopathy [20]. OCTA's precise three-dimensional depiction of the vessels in an MNV also plays a decisive part in interpreting the findings correctly.…”

Section: Discussionmentioning

confidence: 92%

Morphologic analysis of macular neovascularizations by OCT angiography—Technical limitations in the comparison of 3×3mm and 6×6mm images

et al. 2020

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Background The aim of this study was to ascertain whether there are relevant differences between the vascular morphology of macular neovascularizations (MNV) in 3×3mm and 6×6mm images, produced by optical coherence tomography angiography (OCTA). Methods MNV of 49 patients were automated quantitative analysed, measuring area, flow, the fractal dimension, average vessel length, vascular density, and average vessel caliber. These parameters were compared between the 3×3mm and the 6×6mm images. Results A strong linear association was found between the 3×3mm and the 6×6mm images. While area, flow, and FD of the MNV were very similar, the 3×3mm images showed significantly lower average total vessel length, greater vascular density, and lower average vessel caliber. Conclusion In quantitative analysis of the morphologic parameters of MNV in 3×3mm and 6×6mm images, the structures are not directly equivalent in the two sizes of scan. The images must be evaluated on an individual basis.

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Progression of vascular changes in macular telangiectasia type 2: comparison between SD-OCT and OCT angiography

Cited by 28 publications

References 35 publications

Overlap between telangiectasia and photoreceptor loss increases with progression of macular telangiectasia type 2

Overlap between telangiectasia and photoreceptor loss increases with progression of macular telangiectasia type 2

Changes in the OCT angiographic appearance of type 1 and type 2 CNV in exudative AMD during anti-VEGF treatment

Morphologic analysis of macular neovascularizations by OCT angiography—Technical limitations in the comparison of 3×3mm and 6×6mm images

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