Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Retina. 2018 Jul;38(7):1289-1300. doi: 10.1097/IAE.0000000000001863.
To present a postprocessing approach in optical coherence tomography angiography (OCTA) to facilitate the visualization and interpretation of lesions in age-related macular degeneration with coexisting atrophy and choroidal neovascularization (CNV).
This retrospective study included 32 eyes of 26 patients with atrophy and treated CNV and 8 eyes with treatment-naive geographic atrophy. En face optical coherence tomography slabs highlighting atrophy were pseudocolored and merged with the corresponding OCTA. Cross-sectional optical coherence tomography and postprocessed OCTA were analyzed to identify CNV and normal choroidal vessels in relationship to the atrophy. We correlate the OCTA findings with those in a donor eye with treatment-naive geographic atrophy studied with transmission electronic microscopy.
Medium-sized choroidal vessels were displaced anteriorly in areas of atrophy in all 40 eyes (100%), visualized in the choriocapillaris slab in all eyes, and in the outer retinal slab in 30 of 40 eyes (75.0%). Cross-sectional OCTA was used to confirm the presence of CNV. Postprocessing successfully highlighted the CNV and distinguished it from choroidal vessels in atrophy. Donor eye transmission electronic microscopy confirmed the anterior displacement of medium-sized choroidal vessels in geographic atrophy.
The anterior displacement of larger choroidal vessels in atrophy requires clinician vigilance to avoid misinterpreting these vessels as CNV on en face OCTA. Our proposed postprocessing approach offers a potential solution to facilitate the interpretation of en face OCTA in these cases. In the absence of other tools, clinicians are encouraged to rely on the location of flow relative to Bruch membrane on cross-sectional OCTA flow images.
提出一种光学相干断层扫描血管造影（OCTA）后处理方法，以方便观察和解释伴有萎缩和脉络膜新生血管（CNV）的年龄相关性黄斑变性病变。
本回顾性研究纳入了 32 只眼的 26 例伴萎缩性 CNV 患者眼和 8 只未经治疗的地图状萎缩患者眼。假彩色并合并相应 OCTA 的凸显萎缩的 OCT 切片被用于评估。分析横截面 OCT 和后处理 OCTA，以确定 CNV 和正常脉络膜血管与萎缩的关系。我们将 OCTA 发现与未经治疗的地图状萎缩供体眼的透射电子显微镜研究结果进行了相关性分析。
40 只眼中所有（100%）均可见中等大小脉络膜血管向前移位至萎缩区域，所有眼的脉络膜毛细血管层均可见，40 只眼中的 30 只（75.0%）在外视网膜层可见。横截面 OCTA 用于确认 CNV 的存在。后处理技术成功地突出了 CNV，并将其与萎缩中的脉络膜血管区分开来。供体眼透射电子显微镜证实了地图状萎缩中中等大小脉络膜血管的向前移位。
在萎缩中较大脉络膜血管的向前移位需要临床医生保持警惕，以免在 OCTA 表面上误将这些血管视为 CNV。我们提出的后处理方法为解决这些情况下的 OCTA 表面解读提供了一种潜在的解决方案。在没有其他工具的情况下，鼓励临床医生依靠横截面 OCTA 血流图像中血流相对于 Bruch 膜的位置来进行判断。
