Retinal Microvasculature and Visual Acuity in Eyes With Branch Retinal Vein Occlusion: Imaging Analysis by Optical Coherence Tomography Angiography

Wakabayashi, Taku; Sato, Tatsuhiko; Hara-Ueno, Chikako; Fukushima, Yoko; Sayanagi, Kaori; Shiraki, Nobuhiko; Sawa, Miki; Ikuno, Yasushi; Sakaguchi, Hirokazu; Nishida, Kohji

doi:10.1167/iovs.16-21208

Cited by 93 publications

(78 citation statements)

References 58 publications

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“…Our results are consistent with previous studies that addressed the favorable effects of retinal perfusion in the DCP on visual acuity in patients with RVO. 18 Therefore, strategies that preserve retinal perfusion especially in the DCP should be explored to improve visual outcomes after RVO.…”

Section: Discussionmentioning

confidence: 99%

“…The visual improvement after treatment of macular edema significantly correlates with better retinal perfusion and less retinal ischemia in patients with RVO. [16][17][18][19][20][21] Therefore, the effects of repeated anti-VEGF therapy to the retinal perfusion should be investigated for a better longterm management of RVO. Optical coherence tomography angiography (OCTA) enables noninvasive visualization of different retinal layers, such as the superficial and deep retinal capillaries by segmentation of each layer.…”

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confidence: 99%

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Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion

Winegarner

Wakabayashi

Fukushima

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To investigate the changes in the retinal microvasculature during the course of anti-VEGF therapy in eyes with macular edema due to retinal vein occlusion (RVO) and their association with visual outcomes.METHODS. The vessel density (VD) and foveal avascular zone (FAZ) area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were quantitatively measured by optical coherence tomography angiography (OCTA) in 48 consecutive eyes with RVO before and 1, 3, 6, 9, and 12 months after anti-VEGF therapy. Anti-VEGF therapy was performed either with ranibizumab or aflibercept following a pro re nata (PRN) regimen. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA were assessed.RESULTS. The BCVA improved significantly at 12 months (P < 0.001). Better BCVA at 12 months was significantly associated with a better VD in the SCP and DCP both at baseline (R 2 ¼ 0.524, P < 0.001 and R 2 ¼ 0.457, P < 0.001, respectively) and at 12 months (R 2 ¼ 0.521, P < 0.001 and R 2 ¼ 0.662, P < 0.001, respectively). Overall, both VD and FAZ did not change significantly during the 12 months. However, the progression of nonperfusion was observed in the SCP in 6 (13%) eyes and in the DCP in 10 (21%) eyes. The number of macular edema recurrence was significantly associated with a decrease in the VD (P ¼ 0.006 [SCP] and P < 0.001 [DCP]) and less visual gain (P ¼ 0.02) after treatment.CONCLUSIONS. Anti-VEGF therapy maintains retinal perfusion in most patients with RVO. Preserving retinal perfusion is crucial for better visual outcomes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion

Winegarner

Wakabayashi

Fukushima

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…FAZ enlargement is related to worse vision in diabetic retinopathy and retinal vein occlusions. 26,27 Capillary density of both plexuses is correlated to visual loss in diabetic retinopathy, 28 branch retinal vein occlusion, 29,30 and idiopathic macular telangiectasia type 1 (MacTel1). 31 In addition, several investigators have shown that decreased perfusion is more frequent in the deep than superficial plexus, in central or branch vein occlusion, 32-34 diabetic retinopathy, 35 and MacTel1.…”

Section: Discussionmentioning

confidence: 99%

“…36 In resolved branch retinal vein occlusion, deep plexus nonperfusion has recently been identified as a more critical determinant of BCVA than superficial plexus nonperfusion. 30 Noticeably, vascular and structural alterations of radiation maculopathy present similarities with diabetic retinopathy, retinal vein occlusion, or MacTel1, including macular edema, microaneurysms, and capillary nonperfusion. In the present study, OCTA revealed that the deep plexus of irradiated eyes was more severely altered than the superficial plexus.…”

Section: Discussionmentioning

confidence: 99%

Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Matet

Daruich

Zografos

2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To analyze microvascular and structural changes in radiation maculopathy and their influence on visual acuity (VA), using optical coherence tomography (OCT) and OCT angiography (OCTA).METHODS. This was a retrospective analysis of consecutive patients with radiation maculopathy, 12 months or more after proton-beam irradiation for uveal melanoma, imaged with fluorescein angiography, OCT, and OCTA. Clinical parameters potentially affecting VA were recorded, including OCTA-derived metrics: foveal avascular zone (FAZ) area, vascular density, and local fractal dimension of the superficial (SCP) and deep capillary plexuses (DCP). Nonirradiated fellow eyes served as controls. RESULTS.Ninety-three patients were included. FAZ was larger, while SCP/DCP capillary density and local fractal dimension were lower in the 35 irradiated than in the 35 fellow eyes (P < 0.0001). Microvascular alterations graded on fluorescein angiography (minimally damaged/ disrupted/disorganized) were correlated to FAZ area and SCP/DCP density on OCTA (P < 0.01). By univariate analysis, worse VA was associated to macular detachment at presentation (P ¼ 0.024), total macular irradiation (P ¼ 0.0008), higher central macular thickness (CMT) (P ¼ 0.019), higher absolute CMT variation (P < 0.0001), cystoid edema (P ¼ 0.030), ellipsoid zone disruption (P ¼ 0.002), larger FAZ (P < 0.0001), lower SCP (P ¼ 0.001) and DCP capillary density (P < 0.0001), and lower SCP (P ¼ 0.009) and DCP local fractal dimension (P < 0.0001). Two multivariate models with either capillary density or fractal dimension as covariate showed that younger age (P ¼ 0.014/0.017), ellipsoid zone disruption (P ¼ 0.034/0.019), larger FAZ (P ¼ 0.0006/0.002), and lower DCP density (P ¼ 0.008) or DCP fractal dimension (P ¼ 0.012), respectively, were associated with worse VA.CONCLUSIONS. VA of eyes with radiation maculopathy is influenced by structural and microvascular factors identified with OCTA, including FAZ area and DCP integrity.

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“…Using this novel, non-invasive, dyeless technology, it was possible to recognize the presence of the signs of RVO at the level of superficial capillary plexus (SCP) and deep capillary plexus (DCP), as non-perfusion areas, disruption of perifoveal arcade, cysts, and dilation of macular capillaries [1]. In particular, OCTA allowed a direct visualization of DCP, not visible on fluorescein angiography, and particularly involved in RVO [2]. Recently, the OCTA analysis of vessel density (VD) has been correlated with a recurrence of disease and number of intravitreal anti-VEGF injections [3].…”

Section: Introductionmentioning

confidence: 99%

Microvascular Retinal and Choroidal Changes in Retinal Vein Occlusion Analyzed by Two Different Optical Coherence Tomography Angiography Devices

et al. 2019

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Purpose: To investigate retinal and choroidal microvascular changes and structural choroidal involvement in retinal vein occlusion (RVO). Methods: Retrospective analysis of treatment-naïve macular edema secondary to RVO, studied by optical coherence tomography (OCT) and OCT angiography (OCTA), before and after the loading phase of intravitreal injections of ranibizumab (IVR-LP). OCTA was performed using two different devices: AngioVue RTVue XR Avanti (spectral-domain OCTA) and Zeiss PLEX® Elite 9000 (swept-source OCTA). Results: 30 eyes of 30 consecutive patients (17 branch and 13 central RVO) were included. Central macular thickness and subfoveal choroidal thickness (SCT) were significantly reduced after IVR-LP (p < 0.001 and p = 0.046, respectively). 23 eyes were eligible for OCTA analysis. Baseline vessel density (VD) in deep capillary plexus (DCP) was significantly reduced in RVO eyes compared with fellow eyes (p = 0.03 and p = 0.002 for PLEX® Elite and AngioVue, respectively). After IVR-LP, no significant VD changes in any vascular layer was found. PLEX® Elite VD analysis showed significant differences in DCP between ischemic versus non-ischemic eyes (p = 0.011). Conclusion: OCTA suggests a retinal vascular impairment of DCP but no involvement of choroid in RVO eyes. A greater baseline SCT could be due to a choroidal exudation. OCTA imaged with PLEX® Elite allowed to differentiate ischemic and non-ischemic patients at baseline.

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Retinal Microvasculature and Visual Acuity in Eyes With Branch Retinal Vein Occlusion: Imaging Analysis by Optical Coherence Tomography Angiography

Abstract: Preservation of the deep retinal vasculature is crucial for better visual function in BRVO.

Cited by 93 publications

References 58 publications

Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion

Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion

Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Microvascular Retinal and Choroidal Changes in Retinal Vein Occlusion Analyzed by Two Different Optical Coherence Tomography Angiography Devices

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