First Author: M.Loidl GERMANY
Co Author(s): J. Werner C. Enders G. Lang G. Lang
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To compare novel optical coherence tomography angiography (OCT-A) with fluorescein angiography (FA) findings in patients affected by retinal artery occlusion (RAO, central = CRAO, branch = BRAO) as well as selective evaluation of vascular flow changes of superficial and deep retinal vascular layers.
Prospective, masked, monocentre study at the outpatient department of a university eye hospital.
In this prospective study consecutive subjects with acute and chronic CRAO and BRAO were analysed. All patients underwent a complete ophthalmological examination including fundus photography, FA and OCT-A (AngioPlex, Carl Zeiss Meditec, Inc.). Qualitative OCT-A analysis was performed on retinal images segmented in superficial and deep retinal capillary plexus to investigate depth selective differences in perfusion. To determine the more suitable technique for diagnosis of RAO a comparison between OCT-A and FA findings was done. All data obtained was analysed independently by three ophthalmologists.
23 consecutive subjects (6 female, 17 male) were enrolled in this study (16 right and 7 left eyes). The median age of the patients was 68.8 (range 46 to 80) years. 15 patients had acute and 8 patients chronic RAO. Images of OCT-A and FA are highly corresponding in acute and chronic RAO concerning the area of flow reduction or non perfusion. In acute CRAO and BRAO both techniques are equal in the potential of making an unerring diagnosis (35.6 % OCT-A better than FA; 31.1% OCT-A worse than FA; 33.3 % OCT-A equal FA). In acute cases the quality of OCT-A images can be reduced by retinal edema, however data was sufficient for analysis in all cases. In acute occlusions areas of decreased vascular perfusion were in 68.9% more pronounced in the deep in comparison to the superficial retinal capillary plexus. In chronic retinal artery occlusions OCT-A allows a more accurate diagnosis (7/8 OCT-A better than FA; 1/8 OCT-A worse than FA). In chronic occlusions 50% of cases show a more severe perfusion impairment in the deep compared to superficial capillary plexus, in 50% both layers are equally affected.
OCT-A images allow detection of non-perfused areas in patients with acute RAO equal to FA. In eyes with chronic RAO OCT-A is superior to FA. The deep capillary plexus is more severely affected compared to superficial capillary plexus in the majority of RAO. Advantages of OCT-A are that this technique is non-invasive, allows a fast image capture and provides three-dimensional flow information. These findings suggest that OCT-A has the capability to replace FA in the assessment of RAO in most patients.