Angio OCT in Everyday Ophthalmic Practice Bruno Lumbroso, David Huang, Marco Rispoli
INDEX
ABCDEFGHIJLMNOPQRSTUVW
Page numbers followed by b refer to box, f refer to figure, fc refer to flow chart, and t refer to table.
A
Advanced macular degeneration 64, 90
American Academy of Ophthalmology Classification 143
Anastomoses, normal 210, 211
Anemias 166
Aneurysms 176
Angio optical coherence tomography terminology 212, 213
Angioanalytic
data 215
software 210, 211
Angiography devices 18
Angioid streaks 64, 132
Angle closure glaucoma 187
Anticardiolipin 166
Antiplatelet therapy 188
Antivascular endothelial growth factor 81f, 133, 140f
treatment 135f
Aortic aneurysms 186
Arterial occlusions, causes of 186b
Arterial sclerosis 152
Arterial venous anastomoses 176
Arteriography 186
Artifacts, white line 19, 27
Atrophic retinal layers 16f
Autofluorescence 138f
Automated quantitative parameters 107, 108
Avascular retina 60f, 209, 211
outer 59, 60f
B
Bacterial infection 166
Behçet's disease 166
Best disease 64
Blindness 167, 179
Blood
diseases 166
disorders 166
vessel tortuosity 41
Bone fracture, open 186
Branch artery occlusion 184f–186f
Branch retinal vein
edematous occlusion 167b
ischemic occlusion 167b
occlusion 38, 170, 175, 176b, 176f, 177f, 178, 182, 201f
Branch vein occlusion 39f, 164, 170f, 171f, 173f
Brucellosis 166
Bruch's membrane 47f, 53f, 70, 92, 123, 132, 136, 208
Bulbous deformity 190f
Bulk motion artifacts 5f
C
Capillary density 44, 210, 211, 213
high 107
low 108
Capillary diameter 210, 211
Capillary dropout 151, 203
Capillary of deep plexus 185f
Capillary plexus, deep 148
Capillary tortuosity 151, 153
Cardiac catheterization 186
Cardiac valves, artificial 186
Carotid artery
atheroma of 186
occlusion 166
Carotid diseases, internal 186
Cavernous sinus thrombosis 166
Central retinal artery occlusion 38, 178
Central retinal vein
ischemic occlusion 179b
occlusion 38, 143, 177, 178, 182
management of 164
Central serous
chorioretinopathy 52, 68, 90
chronic 127
retinopathy 128f
Central vein occlusions 164
Choriocapillaris 96, 208, 209, 214
optical coherence tomography angiography 214
Chorioretinal anastomosis 56
Chorioretinitis 64
scars 90
Choroid 208
Choroidal branching vascular network 113
Choroidal flows 27
Choroidal hyperpermeability 115f
Choroidal neovascularization 6f, 9, 10f, 14f, 37, 38, 42, 43b, 44b, 45, 48f, 50, 53f, 60, 62, 68, 69, 72, 75, 76, 80, 80f, 82b, 84f–86f, 92, 101, 103–107, 107b, 109, 110, 110f, 114, 123, 127, 128f, 129f, 132, 133f–135f, 136, 138, 139f, 197, 203, 203f, 205, 208, 211–215
capillaries density 44b
causes of 64b
classification 43b
dimensions 107, 108
evaluation 45
formerly classic 46
loops density 44b
management of 72, 90
morphology 54b, 55b, 61b, 63b
surface 203
Choroidal nevus 64
Choroidal osteoma 191
Choroiditis 64, 204
Classic choroidal neovascularization 136f, 137f
Coats' disease 152, 191, 192f
Conventional structural optical coherence tomography 3
Coral bush 107
Corneal haze 27
Cryoglobulinemia 143, 166
Cystoid edema 43, 60f, 150f, 154
cells 167
cysts 210, 211
Cystoid macular edema 150f, 153, 153b
Cystoid spaces, margins of 27
D
Dark halo 56f
Dark large halo surrounding lesion 107, 108
Dense branching structure 107
Dermatomyositis 187
Diabetic fibrovascular membrane 64, 90
Diabetic macular edema 144
management 156
guideline 158fc
Diabetic maculopathies 154b
Diabetic retinopathy 38, 141, 143, 143b, 152, 156f, 166
severe
nonproliferative 147, 149f, 150f
proliferative 161f, 162f
study 38, 156
Diffuse edema 43, 154, 167
Dilated straight vessels, large 111
Drusen 93
of optic disk 166
Dry age-related macular degeneration 92
Dubious retinopathies 204
E
Eales' disease 143, 152, 166
Edematous
branch vein occlusion 168f
cavities, large 167
mixed 164, 178
occlusions 164, 178
Elevated pigment epithelium 47f
Ellipsoid fragmented 167
En face inner retinal angiogram 5f
En face optical coherence
tomographic angiography scans 33f
tomography 144
Endocarditis 166, 186
Epiretinal membranes 167, 179
Extensive retinal ischemia 143
Exudative choroidal neovascularization 42, 45, 61, 63b, 75, 101
management of 72
Eye
disease, age-related 92
movement, noise of 27
F
False-negative flow 19, 24, 25f
artifacts 27b
False-positive flow 14f, 19, 24
artifacts 27b
Fat emboli 186
Fibrotic scar 64, 70f
Fibrovascular scar 63b
Filament-like new vessels 46
Flow area 37, 170
Flow density 154
map 38, 174, 209
Flow projection artifacts 5, 19, 21
Flow quantification 44
Flow speed 41, 203
Fluorangiography shows vessels walls lesions 198
Fluorescein 57, 61
angiography 2, 10, 45, 46, 54b, 66, 67f, 93, 101, 125, 133f, 136f, 144b, 159, 160f, 161f, 164, 165, 168f–171f, 178, 190f, 192f, 193f, 197, 198, 200, 201f–203f, 204, 204b, 205
advantages of 198
Foveal avascular zone 41, 96, 146f, 147, 151, 169, 210
widening of 147, 151
Foveal depression
deformation of 167
lacking 179
Foveal hypoplasia 33f, 34
Foveolar depression 208
G
Ganglion cell layer 4, 30
Ganglion layer 167
Gap defect 21, 22f, 27
Geographic atrophy 92, 95, 97f
Giant cell arteritis 186
Glaucoma 166
optic disk 189
Gliosis 167, 179
Greater fractal dimension 108, 111
H
Hamartoma 192, 193f
Harada's disease 166
Hard exudates 27
Hemorrhage 43, 113f, 167, 168f, 176, 179
Hemorrhagic fevers 166
Henle's fiber layer 4
Herpes zoster 166
Hyaloid 208
Hyperfluorescent dye staining 169f
Hypertension 166, 186
Hypertensive retinopathy 152
Hyperviscosity syndromes 166
I
Idiopathic polypoidal vasculopathy 64
Indocyanine green angiography 10, 57, 61, 93, 116f, 127, 132f, 197, 205
Inner layers, opacity of 187
Intermediate capillary plexus 208
Intraocular pressure 158
Intraretinal
cavities 214
fluid 43
microvascular abnormalities 143, 160
new vessels 160
Intratumoral vessels 193f
Iris 179
Irregular cystic cells 167
Ischemia, management of 181
Ischemic branch vein occlusion 169f
Ischemic maculopathy 154
Ischemic occlusions 164, 178
type 164
J
Juxta-foveal vessels 151
L
Lacking capillaries 108
Laser induced 64
Laser photocoagulation, complications of 64
Laser scars 64, 90
Lens opacities 27
Lesion shape 107, 108
Leukemia 143, 166
Limiting membrane
altered, outer 167, 179
internal 207
normal, outer 187
Line artifacts 5
Lipid exudation 113f
Localized focal edema 167
Low intensity 19
artifacts 27b
imaging 26
Lupus erythematosus 166
M
Macroaneurysms 152b
causes of 152b
Macroglobulinemia 166
Macula 4f
Macular degeneration 16f
age-related 6f, 42, 64, 69–71, 73, 73fc, 90, 90fc, 92, 123, 129f
clinical classification, age-related 92t
Macular disorders 10f
Macular edema 179, 182
diffuse 153b
management of 181
post-RVO management guideline 183fc
Macular serous elevation 154
Macular thickness 177
Maculopathy 154
Maturation 81, 82b
Medusa head 107
Meningioma 166
Meshwork 210, 211
Microaneurysms 151, 176
visualization of 151
Migraine 186
Mitral valve lesions 186
Motion correction technology 2, 21
Movement artifacts 18, 19, 20f, 27b
Multifocal choroiditis 136, 136f
Myeloma, multiple 143
Myopia 64, 123, 124
Myopic choroidal neovascularization 125b
Myopic fibrous scars 90
Myopic membrane 124f
N
Neovascular membrane 123, 212
description 208
Neovascular proliferation 167, 179
Neovascularization, quantification of 6
Nerve fiber 167
layer 4, 29
New vessels
on disk, proliferation of 167, 179
on iris, proliferation of 167
Nonexudative choroidal neovascularization 42, 65, 70b, 71b, 110, 111b
classification of 70b
management of 72
nature of 111b
Nonflow area 37, 154, 170, 209
Nonperiodic recurrences, acute 85
Nonproliferative diabetic retinopathy 141, 144, 145f, 148f, 151b, 156, 202f
angioanalysis, mild 155f
early 142f
management of 141
mild 143, 146f, 147, 148f, 149f, 155f, 156f
Nonvascular flow signal 19, 26
artifacts 27b
Nuclear layer 208
inner 4
outer 4
Numerous microaneurysms clusters 142f
O
Obscuring layers of retina 190f
Occluded capillaries 176
Occult 47f
Ocular
high pressure, accidental 187
movements 19
trauma 166, 187
Optic disk 171f, 209
Optic nerve tumors 166
Optical coherence tomography 42, 54b, 60,62, 68, 69, 73, 76, 90, 97f, 103, 114, 114f, 128f, 129f, 134f, 135f, 137f, 164, 165, 172f, 184, 207, 216
angiography 3, 4f, 6, 8, 12, 14f, 18, 19b, 29, 30, 36, 36b, 42, 46, 55, 56f, 58f, 59, 61, 66, 73, 75, 77f–79f, 89f, 92, 93, 96f, 98, 101, 102, 104–107, 109, 111b, 113, 114, 123, 126, 127, 129f, 131f, 134f, 137f, 138, 141, 143b, 144, 144b, 145, 148, 150f, 151, 151b–153b, 154, 160, 160f–162f, 163–165, 169, 171f, 175, 176b, 179, 180, 187b, 189, 197, 199, 200, 203b, 204, 205, 207, 208, 210, 215b, 216, 216b
advantages of 199
artifacts 5
layer-by-layer analysis 208
management of 73fc, 90fc
methods 1
quantitative parameters 41
report sheet 208
scan 176f, 209
components 167
operate 18
structural 3, 45, 55, 59, 61, 66, 94f, 96f, 126, 144, 165, 179, 187b, 207
Optovue angiovue 60f
technology 1
Oral contraceptives 186
Orbit tumors 166
Osteoma 64, 191, 193f
P
Pachychoroid disorders 71
Papillitis 171f
Parafoveal avascular density 41
Parafoveal macular vasculature 148
Pars planitis 143
Perifoveal arcade 203, 210, 211
Perilesional dark halo 46, 55b, 66
causes of 55b
Peripheral anastomoses 213
Peripheral arcades with anastomoses 111
Peripheral telangiectasia 152
Peripheral vascular, formation of 48f
Photodynamic therapy 132
Photoreceptor layers 4
Photoreceptors severe lesions 43
Pigment accumulation 27
Pigment epithelium 187
detachment 43
fibrovascular flat detachment 43
flat detachment 43
Plexiform layer 208
inner 4, 12
outer 4, 11, 167, 179
Plexus, deep 32
Polyarteritis nodosa 186
Polycythemia 166
Polyglobulinemia 166
Polypoidal choroidal
neovascularization 117f, 118f
vasculopathy 113, 113f, 117f, 121f, 128, 130f, 132f
Polypoidal dilations 131f, 132
Polypoidal vasculopathy 113
Prepapillary neovascularization 159
treatment of 161
Prepapillary new vessels 180
Preretinal neovascularization 180
treatment of 161
Preretinal new vessels 160
Presumed histoplasmosis 64
Prognostic implications 97
Projection artifact 11, 187
Proliferative diabetic retinopathy 141, 143, 159, 161, 163b
early 160f
Proliferative retinopathy, causes of 143b
Pseudohistoplasmosis 64
Pseudovitelliform macular dystrophy 64, 138
Purtscher syndrome 186
Q
Quantitative analysis applications 154
Quiescent choroidal neovascularization 104, 108, 108b
Quincke's edema 198
R
Radial peripapillary capillary plexus 214
Radiation retinopathy 166, 192, 194f
severe 195f
Regional rare causes 166
Reticular dystrophy 138
Reticular pseudodrusen 92, 95, 96f
Retina 154, 167, 179
apparently normal, outer 187
atrophy, inner 187
layers, thickened inner 179
normal 32f
profile irregular 179
swelling of 167, 179
thickness of 167
Retinal angiogram
inner 5f
outer 5f
Retinal angiomatous proliferations 56, 64
Retinal arterial occlusion 187b
Retinal arteriosclerosis 166
Retinal artery occlusions 183
Retinal capillaries 192f
deep 203
Retinal disorders, miscellaneous 189
Retinal edema 168f
diffuse 167, 179
Retinal hemorrhages 27
Retinal inflammations 204
Retinal ischemia 180
Retinal layers, outer 43
Retinal neovascularization 180
Retinal periphery 152
Retinal pigment epithelium 4, 12, 27, 34, 45, 92, 94f, 96f, 113, 127, 139f, 157, 192, 208
elevations 131f
pigmentation, perturbation of 129f
Retinal plexuses 3
Retinal profile 208
irregular 167, 187
Retinal scars, causes of 64b
vascularized 90b
Retinal thrombophlebitis 166
Retinal vascular
anatomy 30f
network 31
deep 210, 211
plexus 4f
deep 208
structure, normal 29
Retinal vasculature, inner 6f
Retinal vein occlusion 174f, 180, 181
management of 180
Retinal vessels 142f
Retinitis 204
Retraction of internal limiting membrane 167, 179
Rickettsia 166
S
Scleroderma 186
Serpiginous 64
Shunts 211
multiple 176
Sickle cell
anemia 143, 166
disease 152
Simultaneous fluorescein angiography 116f
Small capillaries 151
Small vessel branching, secondary 111
Smaller fractal dimension 107
Split-spectrum amplitude-decorrelation angiography 1, 11, 31
Stargardt disease 64
Stretch artefact 19, 20f, 27
Subretinal drusenoid deposits 95
Subretinal exudation 140f
Subretinal fibrosis 88f
Subretinal fluid 43, 113f
Subretinal neovascular membranes, causes of 64b
Superficial capillary plexus 147
Superficial plexus 31, 32f
Superficial retinal
capillaries 203
vascular
network 210
plexus 208
vessels 184f
Superficial vascular
complex 29, 214
network 165, 209
plexus 177f, 178f
angioflow of 175f
T
Takayasu syndrome 166, 187
Talcum in self-injected drugs 186
Tear film 27
Temporal arteritis 186
Thalassemia 143, 166
Thrombosed aneurysms 27
Thrombosed microaneurysms 27
Traction edema 167, 179
Traction maculopathy 154
Traction retinal detachment 167, 179
Traditional fluorescein angiography 205
Trauma 90
Traumatic choroidal ruptures 64
Typical cross-sectional angiogram 5f
Typical polypoidal choroidal vasculopathy 127
U
Uneven capillaries 176
Unknown causes 143
Uveitis 204
V
Vascular abnormalities 210
Vascular arcade
complete 107
incomplete 108
Vascular complexes, deep 29
Vascular congestion 151, 176
Vascular diabetic retinopathy lesions 151b
Vascular dropout area 37, 170
Vascular glaucoma 167, 179
Vascular loops 176
Vascular network
abnormalities of 203
architecture 210, 211
deep 209
Vascular obliteration 186
Vascular plexus 4f
deep 168
Vascularized fibrous scar 85, 87f,–89f
Vasculitis 143, 166
Vein malformations 166
Venous branches, occlusions of 143
Venous occlusions 152, 164
causes of 166b
Vessel
congestion 151, 153
diameter 41, 210, 211
dilatation 176
doubling 21, 27
perimeter index 41
proliferation, new 179
straight 44
thick 44
thin 44
Viral infections 166
Visual acuity 90
Vitreous hemorrhages 27
Vogt–Koyanagi–Harada disease 64
W
Waldenstrom disease 143
Wegener granulomatosis 187
Page numbers followed by b refer to box, f refer to figure, fc refer to flow chart, and t refer to table.
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FM1Angio OCT in Everyday Ophthalmic PracticeFM2
FM3Angio OCT in Everyday Ophthalmic Practice
Bruno Lumbroso MD Director Centro Italiano Macula, Rome, Italy General Secretary, Italian Laser Society Founder and General Secretary Italian Society of OCT Angiography David Huang MD PhD Professor of Ophthalmology and Biomedical Engineering Director, Center for Ophthalmic Optics and Lasers Casey Eye Institute, Oregon Health and Science University Portland, Oregon, USA Marco Rispoli MD Department of Ophthalmology Rome Eye Hospital and Centro Italiano Macula Rome, Italy
FM4
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Angio OCT in Everyday Ophthalmic Practice
First Edition: 2017
9789352700844
FM5CONTRIBUTORS
FM6
FM7PREFACE
An epochal transition is taking place in clinical retinal imaging. In everyday practice, optical coherence tomography (OCT) angiography (OCTA) progressively replaces fluorescein angiography. Optical coherence tomography angiography allows clinicians to view simultaneously both tissue structure and blood flow of retina and choroid. Noninvasive dyeless OCTA clinical use is spreading rapidly all over the world as it is safer, easier, faster, less expensive than fluorescein and indocyanine green (ICG) angiography.
Optical coherence tomography angiography imaging is not immediately intuitive, and its interpretation and acquisition are totally different from fluorescein angiography. Optical coherence tomography angiography users need to learn a novel way of reading imaging. This manual illustrates a logical and simple method of analysis and interpretation of OCTA imaging, clearly stating the easy steps required to reach a diagnosis. The inability to formulate an exact diagnosis derives frequently from an insufficient logical exploitation of one's knowledge.
Optical coherence tomography angiography is already a part of everyday normal eye examination, and the device sits next to the slit lamp in many offices. Structural OCT highlights retinal alterations in morphology and structure of retinal layers. Optical coherence tomography angiography integrates the structural imaging by showing the blood flow.
On account of the universal interest in OCTA and the worldwide expansion of its everyday clinical use, we have written this handbook to support ophthalmologists in their new routine work.
Although OCTA is not yet currently indicated by all clinicians as a substitute for dye angiography, everyday clinical worldwide experience suggests that this technology will soon replace dye angiography for most retinal and choroidal vascular disorders.
Other more important OCTA textbooks delve with technology and physiopathology and study in depth retinal disorders. They are essential for the ophthalmologists.
Most of the images in this manual were recorded with XR Optovue OCT, using AngioVue software, an instrument both reliable and easy to use. The Angio-analytic quantitative software gives a fast and easy measurement of the dropout areas and the vascular density. Monitoring ocular diseases is simplified and more precise.
Illustrated with drawings, outlines, structural and functional OCT figures, this handbook intends to teach OCTA interpretation for routine everyday use, documenting and diagnosing retinal pathologies. Simplified outlines and flowcharts are provided to facilitate interpretation of morphological alterations, and many tables offer guidance through the difficult diagnoses.
Bruno Lumbroso
David Huang
Marco Rispoli
FM9ACKNOWLEDGMENTS
My heartfelt thanks to Jay Wei, CEO of Optovue for long years of active and friendly collaboration.
My gratitude to Nicolas Bruel who concretely helped organize my OCTA teaching.
I would like to thank Donata Piccioli, the artist who illustrated for 30 years all our scientific works and textbooks, for her wonderful drawings and the collaboration in making beautiful artwork out of rudimentary schematic outlines.
Bruno Lumbroso
FM15INTRODUCTION
Clinical ocular coherence tomography (OCT) angiography (OCTA) in everyday use is spreading all over the world, and is slowly replacing the invasive fluorescein angiography. It allows to study both structure and blood flow in retina and choroid. In many disorders, it gives rapidly more precise results than fluorescein angiography (FA).
Meetings and courses all over the world promote the transition from FA to OCTA by education in understanding the new images. OCTA imaging is different from dye angiography. A different interpretation modality is needed. This handbook helps OCTA users in fully understanding the images' clinical meaning.
I had the honor to write this handbook with David Huang, one of the co-inventors of OCT, and inventor with Yali Jia of SSADA technology of OCT angiography, and Marco Rispoli, leading expert and pioneer in OCT angiography and ocular imaging.
Bruno Lumbroso