Understanding OCT Angiography From Pathophysiology to Clinical Imaging Bruno Lumbroso, Marco Rispoli, Eric H Souied, Maria Cristina Savastano, Yali Jia, David Huang
INDEX
Note: Page numbers in bold or italic refer to tables or figures, respectively.
A
Abicipar pegol 101
Acute macular neuroretinopathy (AMN) 161-167, 164165
Aflibercept 99
Age-related macular degeneration (AMD) 7, 35, 45, 55, 195
classification 36
drusen in 35 see also Drusen
dry AMD 45
early stages 35, 51
geographic atrophy 35 see also Geographic atrophy (GA)
late stage 35, 35
modifiable risk factors 37, 45
neovascular AMD, OCTA in 55-58, 5659
neovascularization in, quantification of 5-6, 6
nonmodifiable risk factors 37
pathogenesis 36, 45, 46
prevalence 37
type 1 macular neovascularization with 55, 56
type 2 macular neovascularization with 56, 57
AI see Artificial intelligence (AI)
AMD see Age-related macular degeneration (AMD)
American Academy of Ophthalmology classification of retinopathy 131
Angiogenesis 61, 6264
Angioid streaks 103
AngioVue OCTA system Avanti 6
Antialdosterone 118
Anti-vascular endothelial growth factor (anti-VEGF) therapy 55, 99-102, 100, 103
Artifacts 4-5, 5, 6, 13-16
bulk motion 4, 5, 11
flow projection 4, 5, 10, 13-14, 15
signal reduction 14-15, 16
Artificial intelligence (AI) 13
in image analysis 13, 14, 15, 16
B
Best disease 176-178, 189
Bevacizumab 99
Blood-retina barrier (BRB) 23
inner barrier 23
outer barrier 23-24
Branch artery occlusion 155156
Branch retinal vein occlusion (BRVO) 145, 148-154, 153
deep vascular network in 152
Branch venous occlusion 19, 21, 21
Brolucizumab 102
Bruch's membrane 11, 29
lesion 61
opening (BMO) 200
Bulk motion artifacts 4, 5
C
Capillary pores 23
Central retinal vein occlusion (CRVO) 145-148, 146
Central serous chorioretinopathy (CSC) 113-118
imaging 115-116
management 118
neovascularization in 116-118, 117
pathophysiology 113-114
risk factors 114-115
Chorioretinal anastomosis 80-81, 81
Choroid 30, 30, 189
Choroidal neovascularization (CNV) 35, 61, 73, 103 see also Exudative choroidal neovascularization; Nonexudative choroidal neovascularization
activity features 94, 9697, 96-99
age-related macular degeneration and 65
angiogenesis and 61, 6264
angioid streaks and 103
antiangiogenic factors and angiogenic factors 61
arteriogenesis 65
assessment 66
automated CNV detection using artificial intelligence 14, 15
basic mechanism of 61, 65
biomarkers of CNV activity in exudative AMD 62, 65
Bruch's membrane, abnormalities in 61
capillaries density 66
in children 69
in choroid traumatic rupture 104
classification 61, 62
clinical classification 70-71
definition 65
development of 61-65
early evolution after treatment 91, 9192
effect of projection artifacts on 13
exudative 69, 70
features 66
fibrovascular scars 94, 9495, 104
growth 65
indocyanine green (ICG) features 67
in laser photocoagulation scars 104
loops density 67
loops morphology 67
management 99-102, 100
on margin of atrophic areas 104
maturation after 6 months 91-92, 93
morphology in general 66
in multifocal choroiditis 103-104
myopic 121-122, 122, 123
nonexudative 69, 70
perilesional dark halo 68
physiopathology 61
pigment epithelium cells, alteration in 61
quiescent 97-98
recurrences 92-94, 93
retinal scars, causes of 69
structural OCT features 67
subretinal neovascular membranes, causes of 69
treatment 91
type 1 67, 68
type 2 68
type 3 68
type 4 68
type 1 new vessels fluorescein angiography 67
Yves Salomon Cohen chart 100
Choroidal polypoid vasculopathy (PCV) 40
Choroidal vessels layer 192
Choroid of central serous chorioretinopathy (CSCR) 181
CNV see Choroidal neovascularization (CNV)
Conbercept 101
Cones and rods 28, 29
Cone dystrophy 173
Congenital stationary night blindness (CSNB) 189
Convolutional neural network (CNN) 14
Cotton-wool spots (CWS) 160, 161
CSC see Central serous chorioretinopathy (CSC)
Cuticular drusen 41
D
Decorrelation value 3
Deep capillary plexus (DCP) 159, 166
Diabetic macular edema 133, 136-137
Diabetic maculopathy 132
Diabetic retinopathy (DR) 14, 125, 131
future prospective 128-129
inner blood-retinal barrier (BRB) dysfunction in 125
management of 136-143
pathophysiology 125–127, 125-127
proliferative 128
treatment 127-128
Disorganization of retinal inner layers (DRILs) 132, 161
Dome-shaped macula 181
Doyne honeycomb dystrophy 42, 42
Dropout measurement 19
Drusen 35, 39, 40, 51 see also Age-related macular degeneration (AMD)
classification 39-40, 41
cuticular 41
early AMD grading 43
features 51
ghost 42, 42
growth of 39
hard 40, 41
OCT angiography 39
pachydrusen 40, 41
and pseudodrusen 39, 40
reticular 41, 41-42
small 39
soft 40, 41, 52
in type II membranoproliferative glomerulonephritis 42-43, 43
vascularized 42-43 (see also Vascularized drusen)
Dynamic phototherapy 118
E
Electroretinogram (ERG) 173
Ellipsoid zone 28, 35
Epiretinal membrane (ERM) 183, 187
risk factor 183
EPR–photoreceptor complex, genetics of 189
Examination, OCTA 9-11
boundaries control 11
default settings 11
fixation problems 10
machine handling and protocol 9
mistakes to be avoided 10-11
patient positioning 10
practical problems, fixing of 10
skills for 9
technical tips 10
thresholding algorithm 9-10
Extensive retinal ischemia 132
Exudative choroidal neovascularization 69, 70, 73, 94
arcade morphology 74
capillaries density 74
in children 82
evolution 81-83, 82
features 73
loops compactness 74
morphology 74, 75
perilesional dark halo 75, 79, 79
report 74
retinal scars, causes of 82
structural OCT features 75
subretinal neovascular membranes, causes of 81
type 1 new vessels 75-76, 7578
type 1 + 2 new vessels 76
type 2 new vessels 79-80, 80
type 3 new vessels 80-81, 81
type 1 new vessels fluorescein angiography 74
type 1 new vessels indocyanine green features 74
Eye tracker 10
F
Faricimab (Roche) 102
Fibrocellular lesion 55
Fibrotic scar 83, 83, 94, 9495
Flow projections artifacts 4, 5, 10
Fluorescein angiography (FA) 131, 149, 149150
Foveal avascular zone (FAZ) 133
Full-thickness macular hole (FTMH) 184
Fundus autofluorescence 173
Fundus clinical examination 173
G
GA see Geographic atrophy (GA)
Ganglion cell complex (GCC) 27, 28, 195
Ganglion cell layer (GCL) 209
Geographic atrophy (GA) 35, 40, 45, 55
atrophic progression in 45
classification of atrophy 45-47
clinical features 47
cross-section structural OCT in 47, 47, 48
evolution of 49
future perspective 50
OCTA in 47-48, 48
physiopathogenesis 45
prevention and treatment 49-50
silent nonexudative subclinical CNV 48-49, 49
Ghost drusen 42, 42
Glaucoma 195
classification 196
diagnostic approach 198
risk factors 195
H
Henle fibers 25, 26, 27
Hyper-reflective foci 191
I
Indocyanine green (ICG) angiography 181
Inherited retinal dystrophies (IRD) 189
Inner limiting membrane (ILM) 11
Inner retina 191
genetics of 190
Intermediate capillary plexus (ICP) 159, 166
Intraretinal microvascular abnormalities (IRMAs) 133-136
L
Lamina fusca 30
Leber congenital amaurosis (LCA) 189
M
Macular dystrophies 174
Macular edema 192
Macular scar 55
Microaneurysms 132
Micropulse laser 118
Motion artifacts 4, 5, 11
Müller's cells 25, 26
Multifocal choroiditis (MC) 103-104
Multiple sclerosis (MS) 209
Myopia 121
myopic CNV 121-122, 122, 123
neovascular membranes in 121
N
Neovascularization in age-related macular degeneration, quantification of 5-6, 6
Nerve fiber layer (NFL) infarct 160
Nonexudative choroidal neovascularization 83, 85-88, 98, 99
classification 86
etiology 88
management 87-88
natural history 87
nature of 86
OCT angiography features 86, 87
as precursor to exudation 87
treatment-naïve 89, 90
Nonexudative neovascular AMD 55
Nonproliferative diabetic retinopathy (NPDR) 131-133
early 133136, 138142
O
Optical coherence tomographic angiography (OCTA) 3, 13, 131, 133-136, 145, 147, 149, 150152, 156, 159, 186, 190
advantages 13
artifacts 4-5, 5, 6, 13-16
challenges and improvement scope 13-16
clinical applications 6-7
cross-sectional 3
decorrelation value and flow velocity 3
en face 3
flow index 5
in IRD 192-194
microaneurysms on 132
nonperfusion/capillary dropout area 5
in nonproliferative diabetic retinopathy 131
projection-resolved 4
report writing 215-218
retinal plexuses and segmentation boundaries 4, 4
speckle pattern and flow signal 3
thresholded 9
unthresholded 9
vessel area density 5
vessel length density 5
Optical coherence tomography (OCT) 3, 51, 131, 133-136, 159, 173, 198, 209 in IRD 190-192, 191192
Optical coherence topography (OCT) 183
Optic disk 30
Optic nerve head (ONH) 195
Optic neuritis (ON) 209
Optic neuropathy, assessment 196
P
Pachychoroid neovasculopathy (PNV) 113
Pachydrusen 40, 41, 43
Paracentral acute middle maculopathy (PAMM) 159, 161, 163, 166
PCV see Polypoidal choroidal vasculopathy (PCV)
Photodynamic therapy (PDT) 118
Photoreceptors 28, 29, 35, 190-191
Pigment epithelium-derived factor (PEDF) 61
Polypoidal choroidal vasculopathy (PCV) 107-111
choroid thickness 107, 108
clinical features 108
ICG angiography 108-109
management 111
OCT angiography 109-111
optical coherence tomography 109, 109111
pathophysiology 107-108
Polypoidal choroidal vasculopathy (PCV) 113
Posterior vitreous detachment (PVD) 183
Primary glaucoma 196
classification 111
Projection artifacts 4, 5, 10, 13
effect on choroidal neovascularization 13, 15
projection-resolved OCTA approach 13-14, 15
slab subtraction 13, 15
Projection-resolved OCTA (PR-OCTA) 4, 4, 13-14
healthy eye 14
Proliferative diabetic retinopathy 131, 133-136, 142
in pregnant patient 143
Pseudovitelliform macular degeneration 177-178
Q
Quantitative assessment 19-21
flow area 19, 19, 20
flow density map 19, 21, 21
flow speed 21
nonflow area 19, 20
vascular dropout area 19
R
Radial peripapillary capillary plexus (RPCP) 159, 166
Radial peripapillary capillary (RPC) 198
Ranibizumab 99, 101
Reticular pseudodrusen 41, 41-42
Retina
blood-retinal barrier 23-24
Bruch's membrane 29
choroid 30, 30
deep vascular network 31
framework 25, 25
horizontal scaffold 27-28
inner blood-retinal barrier 23
inner retina 27, 28
leakage from retinal vessels 24
Müller cells and Henle fibers 25, 26
normal retinal vasculature anatomy 24, 31-32, 3133
OCT and OCT angiography 24, 24-25, 25
optic disk 30
outer blood-retinal barrier 23-24
outer retina 27-28
photoreceptors, cones and rods 28, 29
pigment epithelium 29
sclera 30, 30
superficial vessels 31
vertical scaffold 25, 27, 28
Retinal angiomatous proliferations 80-81, 81
Retinal artery occlusions 154-155
Retinal capillary ischemia 167
Retinal pigment epithelium (RPE) 23, 29, 39
Retinal plexuses 4, 4
Retinal nerve fiber layer (RNFL) 185, 186187, 191-192, 209
Retinitis pigmentosa 189
S
Sclera 30, 30
Shadow artifacts 4-5, 6
Signal reduction artifacts 14-15, 16
Split-spectrum amplitude-decorrelation angiography (SSADA) 3
Stargardt disease 174-176, 175176
Subretinal drusenoid deposits (SDD) 41, 43
Superficial capillary plexus (SCP) 159, 166
Suprachoroidal space 30
T
Three-dimensional (3D) functional cube 10
Type II membranoproliferative glomerulonephritis 42-43, 43
V
Vascular endothelial growth factor (VEGF) 61
Vascularized drusen 42-43, 51-54, 53
Venous occlusions 145
Virchow's triad 145
Vision loss see Age-related macular degeneration (AMD)
Vitreomacular adhesion (VMA) 183
Vitreomacular traction (VMT) 183
Vitreoretinal interface (VMI) 183
W
White dot syndromes 104
X
X-linked retinoschisis 189
Z
Ziv-aflibercept 101
Zonulae occludentes 23-24
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