Optical Coherence Tomography Angiography Analysis of the Foveal Avascular Zone and Macular Vessel Density After Anti-VEGF Therapy in Eyes With Diabetic Macular Edema and Retinal Vein Occlusion

Falavarjani, Khalil Ghasemi; Iafe, Nicholas A.; Hubschman, Jean‐Pierre; Tsui, Irena; Sadda, Srinivas R.; Sarraf, David

doi:10.1167/iovs.16-20579

Cited by 150 publications

(118 citation statements)

References 25 publications

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“…In agreement with the findings of Carpineto et al [12] and Mastropasqua et al [13], we detected excellent repeatability and reproducibility in FAZ area measurement when measuring the FAZ at the SCP [12, 13]. On the contrary, repeatability and reproducibility were lower when measuring the FAZ area at the DCP, in agreement with the finding of Ghasemi Falavarjani et al [6]. FAZ limits can be clearly identified at the more superficial layer, whereas in the deeper retina the edge points along the centerline of the vessels are more difficult to delineate.…”

Section: Discussionsupporting

confidence: 92%

“…When comparing fluorescein angiography and OCTA in the classification of diabetic retinopathy, OCTA allows better discrimination of FAZ disruption and capillary dropout in the superficial retinal layers [11]. Moreover, OCTA can separately visualize the SCP and the DCP; therefore, the possible different involvement of FAZ in these 2 plexuses is under investigation [6]. In agreement with the findings of Carpineto et al [12] and Mastropasqua et al [13], we detected excellent repeatability and reproducibility in FAZ area measurement when measuring the FAZ at the SCP [12, 13].…”

Section: Discussionmentioning

confidence: 99%

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Repeatability and Reproducibility of Foveal Avascular Zone Area Measurement on Normal Eyes by Different Optical Coherence Tomography Angiography Instruments

Pilotto¹,

Frizziero²,

Crepaldi³

et al. 2018

Ophthalmic Res

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Purpose: To compare the foveal avascular zone (FAZ) area measurements produced by different optical coherence tomography angiography (OCTA). Methods: Healthy enrolled volunteers underwent OCTA using 2 different devices: Spectralis HRA+OCTA (Heidelberg Engineering, Heidelberg, Germany) and RS-3000 Advance (Nidek, Gamagori, Japan). Two graders measured FAZ in both superficial (SCP) and deep (DCP) retinal capillary plexuses. The SCP and DCP en face images were visualized automatically segmenting 2 separate slabs defined by the arbitrary segmentation lines created by the software of each OCT device. One grader repeated each measure twice. Results: Fifty-nine eyes were included. The mean FAZ was 0.33 ± 0.09 mm² at the SCP and 0.57 ± 0.17 mm² at the DCP measured with RS-3000 versus 0.30 ± 0.08 and 0.35 ± 0.08 mm², respectively, measured with Spectralis. The measurements of the 2 devices were significantly different (p < 0.0001). The intraoperator agreement was excellent at the SCP (intraclass correlation coefficient, ICC: 0.97 with Spectralis and 0.96 with RS-3000). At the DCP, it was good with Spectralis and fair with RS-3000 (ICC: 0.85 and 0.64, respectively). The interoperator agreement was excellent for Spectralis and good for RS-3000 at the SCP (ICC: 0.97 and 0.93, respectively). It was good at the DCP with both devices (ICC: 0.74 with RS-3000 and 0.81 with Spectralis). Conclusions: FAZ measurements obtained with different OCTA devices differ. These findings should be considered in follow-up studies of patients with retinal vascular diseases.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Repeatability and Reproducibility of Foveal Avascular Zone Area Measurement on Normal Eyes by Different Optical Coherence Tomography Angiography Instruments

Pilotto¹,

Frizziero²,

Crepaldi³

et al. 2018

Ophthalmic Res

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“…Therefore, perfused retinal capillaries can be mostly maintained for at least 12 months with anti-VEGF therapy as indicated by the previous reports. 29,30 Alternatively, the onceoccluded capillaries may not achieve complete reperfusion even after successful treatment of the macular edema.…”

Section: Discussionmentioning

confidence: 99%

“…To date, several studies have reported the macular VD and FAZ before and after anti-VEGF therapy. [28][29][30] However, the results are conflicting because of the short follow-up periods and a limited number of patients studied. In addition, the possible associations between changes in the retinal VD and visual outcomes have not been reported.…”

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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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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“…FA-based studies have demonstrated that sustained anti-VEGF therapy in subjects with DR slows or even reverses retinal non-perfusion (Campochiaro, Wykoff et al 2014). However, Falavarjani et al recently showed that there is no difference in retinal capillary density or FAZ area in subjects with DR or RVO, before and after a single intravitreal injection of anti-VEGF agents for macular edema (Ghasemi Falavarjani, Iafe et al 2017). It is likely that one month is not a sufficient duration of treatment to observe any changes in perfusion, and future studies are needed to address this.…”

Section: Review Of Clinical Studies Utilizing Octamentioning

confidence: 99%

Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications

Kashani

Chen

Gahm

et al. 2017

Progress in Retinal and Eye Research

714

561

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OCT has revolutionized the practice of ophthalmology over the past 10 to 20 years. Advances in OCT technology have allowed for the creation of novel OCT-based methods. OCT-Angiography (OCTA) is one such method that has rapidly gained clinical acceptance since it was approved by the FDA in late 2016. OCTA images are based on the variable backscattering of light from the vascular and neurosensory tissue in the retina. Since the intensity and phase of backscattered light from retinal tissue varies based on the intrinsic movement of the tissue (e.g. red blood cells are moving, but neurosensory tissue is static), OCTA images are essentially motion-contrast images. This motion-contrast imaging provides reliable, high resolution, and non-invasive images of the retinal vasculature in an efficient manner. In many cases, these images are approaching histology level resolution. This unprecedented resolution coupled with the simple, fast and non-invasive imaging platform have allowed a host of basic and clinical research applications. OCTA has been shown to demonstrate many important clinical findings including areas of macular telangiectasia, impaired perfusion, microaneurysms, capillary remodeling, some types of intraretinal fluid, and neovascularization among many others. More importantly, OCTA provides depth-resolved information that has never before been available. Correspondingly, OCTA has been used to evaluate a spectrum of retinal vascular diseases including diabetic retinopathy (DR), retinal venous occlusion (RVO), uveitis, retinal arterial occlusion, and age-related macular degeneration among others. In this review, we will discuss the methods used to create OCTA images, the practical applications of OCTA in light of invasive dye-imaging studies (e.g. fluorescein angiography) and review clinical studies demonstrating the utility of OCTA for research and clinical practice.

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Optical Coherence Tomography Angiography Analysis of the Foveal Avascular Zone and Macular Vessel Density After Anti-VEGF Therapy in Eyes With Diabetic Macular Edema and Retinal Vein Occlusion

Abstract: In this pilot study, retinal capillary density and FAZ area remained statistically unchanged in the short-term after a single intravitreal injection of an anti-VEGF agent.

Cited by 150 publications

References 25 publications

Repeatability and Reproducibility of Foveal Avascular Zone Area Measurement on Normal Eyes by Different Optical Coherence Tomography Angiography Instruments

Repeatability and Reproducibility of Foveal Avascular Zone Area Measurement on Normal Eyes by Different Optical Coherence Tomography Angiography Instruments

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

Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications

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