Residual Choroidal Vessels in Atrophy Can Masquerade as Choroidal Neovascularization on Optical Coherence Tomography Angiography

Nesper, Peter L.; Lutty, Gerard A.; Fawzi, Amani A.

doi:10.1097/iae.0000000000001863

Cited by 19 publications

(18 citation statements)

References 33 publications

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“…Another possibility could be that the choriocapillaris is completely obliterated in areas with RPD allowing us to visualize the flow in the underlying Sattler’s layer of medium sized choroidal vessels (manuscript in review). 44 All of these scenarios would likely result in hypoxia of the RPE and photoreceptors, and a reduction in the metabolic supply necessary for photoreceptor visual function. We hypothesize that this decrease in choriocapillaris perfusion is global in eyes with RPD explaining the correlation between visual acuity and non-perfusion of the choriocapillaris in these eyes.…”

Section: Discussionmentioning

confidence: 99%

Choriocapillaris Nonperfusion is Associated With Poor Visual Acuity in Eyes With Reticular Pseudodrusen

Nesper

Soetikno

Fawzi

2017

American Journal of Ophthalmology

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119

124

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Purpose To study choriocapillaris blood flow in age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA) and study its correlation to vision (VA) in eyes with reticular pseudodrusen (RPD) versus those with drusen without RPD (drusen). Design Cross-sectional study Methods Patients with either drusen or RPD in early AMD underwent OCTA imaging of the superior, inferior, and/or nasal macula. We quantified “percent choriocapillaris area of non-perfusion” (PCAN) in eyes with RPD versus those with drusen. We assessed the repeatability of PCAN and its correlations with VA. Results Twenty-nine eyes of 26 patients with RPD and 21 eyes of 16 age-matched AMD patients with drusen were included. Qualitatively, the choriocapillaris in areas with RPD showed focal dark regions without flow signal on OCTA (non-perfusion). The repeatability coefficient of PCAN was 0.49%. Eyes with RPD had significantly greater PCAN compared to eyes with drusen (7.31% and 3.88%, respectively; P < 0.001). We found a significant correlation between PCAN and VA for the entire dataset (r = 0.394, P = 0.005). When considering eyes with RPD separately, this correlation was stronger (r = 0.474, P = 0.009) but lost significance when considering eyes with drusen separately (r = 0.175, P = 0.45). Conclusions Eyes with RPD have significantly larger areas of choriocapillaris non-perfusion compared to eyes with drusen and no RPD. The correlation between PCAN and VA in this RPD population provides a potential mechanistic explanation for vision compromise in RPD compared to other forms of drusen in AMD.

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Section: Discussionmentioning

confidence: 99%

Choriocapillaris Nonperfusion is Associated With Poor Visual Acuity in Eyes With Reticular Pseudodrusen

Nesper

Soetikno

Fawzi

2017

American Journal of Ophthalmology

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119

124

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“…Flow signal in the B-scan has been shown to be crucial, as residual choroidal vessels in atrophy could mimic CNV and potentially confound these studies. 25 Studies further differed in the OCTA scan size used. It is plausible that smaller scans with higher scan density may be better at detecting the earliest subclinical CNV.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Subclinical CNV and Choriocapillaris Nonperfusion in Fellow Eyes of Unilateral Exudative AMD on OCT Angiography

Treister

Nesper

Fayed

et al. 2018

Trans. Vis. Sci. Tech.

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PurposeTo determine the prevalence of subclinical choroidal neovascularization (CNV) in fellow eyes of patients with unilateral exudative age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA) and to quantify choriocapillaris nonperfusion adjacent to CNV.MethodsWe retrospectively reviewed all patients with AMD who underwent OCTA and identified eyes with unilateral exudative AMD. We determined the presence of subclinical CNV on custom en face macular slabs of the outer retina and choriocapillaris and confirmed on cross-sectional scans. Two graders quantified the percent choriocapillaris area of nonperfusion (PCAN) in the entire choriocapillaris slab as well as in the “halo” zone (200 μm) surrounding subclinical and exudative CNV lesions.ResultsOf 140 AMD patients who underwent OCTA, 34 had unilateral exudative AMD, with five of the 34 fellow eyes (14.7%) having subclinical CNV. Compared with PCAN in the entire slab (10.333 ± 4.288%), we found that “halo” PCAN, surrounding CNV, was significantly higher (13.045 ± 5.809%; P < 0.001). Further, there was a trend for higher PCAN in exudative CNV eyes (15.267 ± 7.230%) compared with their fellow subclinical CNV eyes (10.823 ± 3.365%, P = 0.115).ConclusionsThere is a notable prevalence of subclinical CNV in fellow eyes with unilateral exudative CNV, and significantly greater choriocapillaris nonperfusion adjacent to all CNV lesions. We identified a trend for increased choriocapillaris nonperfusion in exudative AMD eyes as compared with their fellow subclinical CNV eyes, which deserves further study.Translational RelevanceOCTA can be useful in clinical practice to detect subclinical CNV and study choriocapillaris dysfunction.

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“…Moreover, artifacts includes segmentation, motion, blink, masking, unmasking, vessel doubling, and banding and out of window artifacts were demonstrated common in OCTA images, especially in eyes with pathology [ 10 ]. Furthermore, study showed that the anterior displacement of larger choroidal vessels in geographic atrophy could masquerade as choroidal neovascularization (CNV) on en face OCTA, so cross-sectional OCTA used in conjunction with en face OCTA was necessary for confirming the presence of CNV [ 18 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Retinal pigment epithelium hyperplasia overlying pigment epithelial detachment in age-related macular degeneration can masquerade as neovascularization on optical coherence tomography angiography

Chen

Zhang

Gan

et al. 2018

Graefes Arch Clin Exp Ophthalmol

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PurposeTo report the image artifacts due to retinal pigment epithelium (RPE) hyperplasia overlying retinal pigment epithelial detachment (PED) in age-related macular degeneration (AMD), which can masquerade as neovascularization on optical coherence tomography angiography (OCTA).MethodsA hospital-based, retrospective, and cross-sectional study. Twenty-two eyes from 16 patients with non-vascularized PED related to AMD were included in this study. All patients were examined by OCTA, spectral-domain optical coherence tomography, fluorescence angiography, and indocyanine green angiography. Vascular flow signals (VFS) on both the outer retinal slab of en face OCTA and cross-sectional OCTA and their correspondence with RPE hyperplasia were evaluated.ResultsFifteen eyes (68.2%) showed VFS on both the outer retina slab of en face OCTA and cross-sectional OCTA, all corresponding to the RPE hyperplasia overlying PED. Among them, 12 eyes with lump RPE hyperplasia outside foveal avascular zone (FAZ) all showed obvious VFS on the outer retina slab of OCTA, and 3 eyes with scattered RPE hyperplasia outside FAZ showed VFS fragments. Of note, 4 eyes had accompanied RPE hyperplasia inside FAZ, and 7 eyes without RPE hyperplasia overlying PED showed no corresponding VFS on the outer retina slab of OCTA. Additionally, a round-like dark band at the edge of PED was observed in the outer retina slab on en face OCTA in 17 eyes (77.3%).ConclusionsRPE hyperplasia overlying PED in AMD can masquerade as neovascularization on OCTA. To avoid misdiagnosis and unnecessary treatment, this RPE hyperplasia-related image artifact should be considered when interpreting OCTA images.

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Residual Choroidal Vessels in Atrophy Can Masquerade as Choroidal Neovascularization on Optical Coherence Tomography Angiography

Cited by 19 publications

References 33 publications

Choriocapillaris Nonperfusion is Associated With Poor Visual Acuity in Eyes With Reticular Pseudodrusen

Choriocapillaris Nonperfusion is Associated With Poor Visual Acuity in Eyes With Reticular Pseudodrusen

Prevalence of Subclinical CNV and Choriocapillaris Nonperfusion in Fellow Eyes of Unilateral Exudative AMD on OCT Angiography

Retinal pigment epithelium hyperplasia overlying pigment epithelial detachment in age-related macular degeneration can masquerade as neovascularization on optical coherence tomography angiography

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