Ahmed Daniel, Stattin Martin, Haas Anna-Maria, Kickinger Stefan, Gabriel Maximilian, Graf Alexandra, Krepler Katharina, Ansari-Shahrezaei Siamak
Karl Landsteiner Institute for Retinal Research and Imaging, Rudolf Foundation Hospital, Juchgasse 25, Vienna 1030, Austria.
Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse 25, Vienna 1030, Austria.
J Ophthalmol. 2021 Feb 16;2021:6695918. doi: 10.1155/2021/6695918. eCollection 2021.
To evaluate the capability of swept source-optical coherence tomography angiography (SS-OCTA) in the detection and localization of treatment-naive macular neovascularization (MNV) secondary to exudative neovascular age-related macular degeneration (nAMD).
In this prospective, observational case series, 158 eyes of 142 patients were diagnosed with exudative nAMD using fluorescein (FA) and indocyanine green angiography (ICGA) and evaluated by SS-OCTA in a tertiary retina center (Rudolf Foundation Hospital Vienna, Austria). The main outcome measure was the sensitivity of SS-OCTA compared to the standard multimodal imaging approach. Secondary outcome measure was the anatomic analysis of MNV in relation to the retinal pigment epithelium.
En-face SS-OCTA confirmed a MNV in 126 eyes (sensitivity: 79.8%), leaving 32 eyes (20.2%) undetected. In 23 of these 32 eyes (71.9%), abnormal flow in cross-sectional SS-OCTA B-scans was identified, giving an overall SS-OCTA sensitivity of 94.3%. Eyes with a pigment epithelium detachment (PED) ≥ 300 m had a smaller probability for correct MNV detection (=0.015). Type 1 MNV showed a trend (=0.051) towards smaller probability for the correct detection compared to all other subtypes. Other relevant factors for the nondetection of MNV in SS-OCTA were image artifacts present in 3 of 32 eyes (9.4%). SS-OCTA confirmed the anatomic localization of 93 in 126 MNVs as compared to FA (sensitivity: 73.8%). There was no influence of age, gender, pseudophakia, visual acuity, central foveal thickness, or subfoveal choroidal thickness on the detection rate of MNV.
SS-OCTA remains inferior to dye-based angiography in the detection rate of exudative nAMD consistent with type 1 MNV and a PED ≥300 m. The capability to combine imaging modalities and distinguish the respective MNV subtype improves its diagnostic value.
评估扫频源光学相干断层扫描血管造影（SS-OCTA）检测和定位初治的渗出性年龄相关性黄斑变性（nAMD）继发的黄斑新生血管（MNV）的能力。
在这个前瞻性观察性病例系列中，142例患者的158只眼经荧光素（FA）和吲哚菁绿血管造影（ICGA）诊断为渗出性nAMD，并在一家三级视网膜中心（奥地利维也纳鲁道夫基金会医院）接受SS-OCTA评估。主要观察指标是SS-OCTA与标准多模态成像方法相比的敏感性。次要观察指标是MNV相对于视网膜色素上皮的解剖学分析。
表面SS-OCTA在126只眼中确认存在MNV（敏感性：79.8%），32只眼（20.2%）未被检测到。在这32只眼中的23只（71.9%），横断面SS-OCTA B扫描中发现了异常血流，SS-OCTA的总体敏感性为94.3%。色素上皮脱离（PED）≥300μm的眼正确检测MNV的概率较小（P=0.015）。与所有其他亚型相比，1型MNV正确检测的概率有降低趋势（P=0.051）。SS-OCTA未检测到MNV的其他相关因素是32只眼中有3只（9.4%）存在图像伪影。与FA相比，SS-OCTA确认了126例MNV中93例的解剖定位（敏感性：73.8%）。年龄、性别、人工晶状体眼、视力、中心凹厚度或黄斑下脉络膜厚度对MNV的检测率没有影响。
在检测与1型MNV和PED≥300μm一致的渗出性nAMD方面，SS-OCTA的检测率仍低于基于染料的血管造影。联合成像模式并区分各自MNV亚型的能力提高了其诊断价值。
