Posters

Comparison of coherence tomography angiography and fluorescein angiography in the assessment of retinal vein occlusion

Poster Details

First Author: C.Chung HONG KONG

Co Author(s):    H. Tang   S. Li   K. Li                       

Abstract Details



Purpose:

1. To compare the imaging of retinal vein occlusion (RVO) with optical coherence tomography angiography (OCT-A) and fluorescein angiography (FA) 2. To evaluate the role of the two imaging modalities in clinical management

Setting:

The study was conducted by the Kowloon East Cluster Ophthalmic Service (United Christian Hospital and Tseung Kwan O Hospital). It was approved by the Research Ethics Committee of the Hospital Authority (Ref: KC/KE-16-0229/ER-1) and compliant to the Declaration of Helsinki.

Methods:

This is a consecutive case series of all patients with RVO from 1st June 2015 - 31th August 2015. Fluorescein angiography (FA) was performed with the Heidelberg Retinal Angiography and optical coherence tomography System (Spectralis®, HRA-OCT; Heidelberg Engineering, Germany). Optical coherence tomography angiography (OCT-A) was performed with the AngioVue software on the RTVue XR Avanti Spectral Domain OCT (Optovue Inc., Fremont, CA) using the 3 x 3 mm scanning protocols. All ophthalmic imaging was performed by a single ophthalmic photographer. The patient identity of the FA and OCT-A reports was independently coded. An experienced retinal specialist blinded from patient identity assessed the imaging reports according to the presence or absence of the following parameters: 1. Enlargement of foveal avascular zone (FAZ) 2. Capillary non-perfusion 3. Microaneurysm 4. Venous congestion 5. Vascular tortuosity The agreement between FA and OCT-A was assessed with Cohen’s kappa coefficient on SPSS 20.0 for windows. A significant level of p < 0.05 was taken.

Results:

In the study period, twelve RVO patients were evaluated with both OCT-A and FA. Between FA and OCT-A, good agreement was found for microaneurysms (100%, Kappa’s coefficient 1, p = 0.001) and venous congestion (83.33%, Kappa’s coefficient 0.571, p = 0.028). For the parameters of FAZ enlargement, venous congestion and tortuosity, poor agreement was found between FA and OCT-A (p > 0.05). OCT-A revealed much more capillary non-perfusion (91.67%, 11/12 cases) than FA (58.33%, 7/12 cases). OCT-A also revealed more FAZ enlargement (75.00%, 9/12 cases) than FA (33.33%, 4/12 cases). On FA, vascular leakage was shown in 83.33% (10/12 cases).

Conclusions:

For RVO, OCT-A is able to reveal more FAZ enlargement and capillary non-perfusion. Inherent to the principle of imaging, vascular leakage is only shown on FA. While the retinal perfusion status and the need for pan-retinal photocoagulation (PRP) is better assessed on OCT-A, vascular leakage from neovascularization as shown on FA is useful for the assessment of treatment response. Albeit having good agreement between FA and OCT-A, the parameters of microaneurysms and venous congestion are less useful for prognostic purpose and guidance of management. OCT-A and FA are complementary tools in the evaluation of retinal perfusion in RVO. The need for PRP is better assessed on OCT-A, while FA has its value in assessing treatment response.

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