Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham.
University Hospital Würzburg, Würzburg, Germany.
JAMA Ophthalmol. 2022 Jun 1;140(6):628-633. doi: 10.1001/jamaophthalmol.2022.0890.
By validating optical coherence tomography angiography (OCTA) in the analysis of type 3 macular neovascularization secondary to age-related macular degeneration, the overall value of clinical OCTA for disease observation, diagnosis, and staging is increased.
To assess the association of in vivo OCTA of type 3 macular neovascularization secondary to age-related macular degeneration with corresponding ex vivo histology.
DESIGN, SETTING, AND PARTICIPANTS: This study included clinical imaging, laboratory microscopy, and eye-tracked clinicopathologic correlation of a single case from a community-based practice evaluated at a university-based research laboratory from 2014 to 2019.
Infrared reflectance and eye-tracked spectral-domain OCTA clinical imaging was correlated with ex vivo high-resolution histologic images of the preserved donor eye. Eye tracking, applied to the donor eye, enabled identification of histologic features corresponding with clinical OCTA signatures. Projection artifact removal based on 2-dimensional vessel-shape estimation and a Gaussian blur filter demonstrated a robust preservation of neovascular flow signal.
Histology findings associated with clinical OCTA signatures. Three-dimensional view of neovascularization via video.
A White woman in her 90s with type 3 neovascularization secondary to age-related macular degeneration was treated with 37 intravitreal injections of ranibizumab and aflibercept in the right eye. The index lesion displayed a drusenoid pigment epithelium detachment, characteristic of type 3 neovascularization. OCTA decorrelation signal in the index lesion corresponded in histology to a collagen-ensheathed vascular complex contacting basal laminar deposit that outlasted the retinal pigment epithelium. The subretinal pigment epithelium-basal laminar space contained calcified material and glial processes. No connection between the choriocapillaris and this space was observed. Video showed a columnar tangle of flow signal in the outer nuclear layer, with inflow and outflow vessels connecting to the superficial artery and vein.
While this study presents only 1 case in which a vascular connection between subretinal pigment epithelium-basal laminar space and choriocapillaris was undetected, these results support the potential value of OCTA for diagnosis. OCTA decorrelation signal of type 3 neovascularization corresponded with intraretinal neovessels on histology. Projection artifact removal based on 2-dimensional vessel-shape estimation and Gaussian blur filter demonstrated their potential value for further use in OCTA decorrelation signal processing.
通过验证与年龄相关性黄斑变性相关的 3 型黄斑新生血管的光学相干断层扫描血管造影（OCTA），提高了临床 OCTA 在疾病观察、诊断和分期方面的整体价值。
评估与年龄相关性黄斑变性相关的 3 型黄斑新生血管的体内 OCTA 与相应的离体组织病理学的相关性。
设计、设置和参与者：本研究纳入了 2014 年至 2019 年在一家社区实践中进行的一项基于单病例的临床成像、实验室显微镜检查以及在大学研究实验室进行的眼跟踪临床病理相关性研究。
红外反射和眼跟踪的光谱域 OCTA 临床成像与保留下的供体眼的离体高分辨率组织学图像相关联。应用于供体眼的眼跟踪技术能够识别与临床 OCTA 特征相对应的组织学特征。基于 2 维血管形状估计和高斯模糊滤波器的投影伪影去除显示出对新生血管信号的稳健保留。
与临床 OCTA 特征相关的组织学发现。通过视频观察新生血管的 3 维视图。
一位 90 多岁的白人女性，右眼患有与年龄相关性黄斑变性相关的 3 型新生血管，接受了 37 次雷珠单抗和阿柏西普玻璃体内注射治疗。该指数病变显示出典型的 3 型新生血管特征，即有玻璃膜疣样色素上皮脱离。在指数病变中 OCTA 去相关信号在组织学上对应于一个胶原鞘血管复合物，该复合物与基底膜沉积物接触，持续存在于色素上皮下。视网膜色素上皮下-基底膜间隙含有钙化物质和胶质过程。在该空间中没有观察到脉络膜毛细血管与该空间的连接。视频显示，外核层中有一个柱状的血流信号缠结，有流入和流出血管与浅层动脉和静脉相连。
虽然本研究仅提供了一个血管连接在视网膜色素上皮下-基底膜间隙和脉络膜毛细血管之间未被检测到的病例，但这些结果支持 OCTA 在诊断中的潜在价值。3 型新生血管的 OCTA 去相关信号与组织学上的视网膜内新生血管相对应。基于 2 维血管形状估计和高斯模糊滤波器的投影伪影去除显示了它们在 OCTA 去相关信号处理中的潜在价值。
