First Author: Y.Sidorova RUSSIA
Co Author(s): A. Tereschenko I. Trifanenkova Y. Sidorova
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Despite the peculiar ophthalmoscope features and specific SOCT data, it is not always possible to make a correct diagnosis in the early stages of the idiopathic macular telangiectasia, and, consequently, to choose the correct tactics of patient management. This quite often leads to serious complications with severe disturbances in retina structure and irreversible loss of central vision. PURPOSE is to assess the informativity of spectral optical coherence tomography (SOCT) with OCT-Angiography (OCT-A) in diagnosis of type 2 idiopathic macular telangiectasia.
Kaluga branch of FGAU' MNTK 'Eye Microsurgery' named after acad. S.N. Fedorov'
14 patients (28 eyes) with type 2 idiopathic macular telangiectasia aged from 53 to 69 years old were examined. In addition to standard ophthalmic examination, that includes visual acuity, biomicroscopy, direct and indirect ophthalmoscopy, all the patients underwent fundus photography, fluorescein angiography and SOCT in Angio-ОСТ mode (OCT-A). Device RTVue XR Avanti (Optovue, USA) was used for SOCT in modes Cross Line, Macular Map, 3D Widefield MCT. OCT-A was performed using SSADA algorithm in angio retina mode. The scanning zones sizes during OCT-A were 3×3 and 6×6 mm. Scanning was performed in the macular area with central fixation in all cases. The degree of structural retinal disorders and retinal thickness were evaluated by SOCT in perifoveal region. In OCT-A images the peculiarities and extent of changes in superficial and deep retinal capillary bed were defined, the vascular density of the superficial retinal plexus, and the presence or absence of neovascular net at the level of outer retinal and choroidal layers were estimated.
All patients were divided into 4 groups in according to structural retinal disorders and complicated processes. Group 1 – 5 patients (10 eyes) with initial signs of the disease; group 2 – 5 patients (9 eyes) with the moderate signs; group 3 – 4 patients (8 eyes) with complicating subretinal neovascularization, group 4 – 1 patients (1 eyes) with complicating macular hole. In Group 1, best corrected visual acuity (BCVA) was 0.8-0.9 decimals. OCT-A showed aneurysmal enlargement of retinal capillary network in superficial and deep plexus at temporal parafoveal region, much vascular anomalies in deep capillary plexus with decreased vessels density. In Group 2, BCVA was lower (0.5-0.7). OCT-A revealed capillary aneurysmal dilations in superficial and deep plexus, and decreased blood vessels density in superficial and deep capillary bed at temporal area. In Group 3, BCVA varied from 0.05 to 0.6. OCT-A showed vast 'tree-like' neovascular network in subretinal neovascular membrane projection. The regions of flat transudative neurosensory retina detachment were visualized over pigment epithelial detachment. Retinal thickness was markedly reduced due to atrophy (154-196 µm). In Group 4, BCVA was significantly reduced, because of macular hole. OCT-A revealed significantly reduced retinal vessels density, disturbance of capillaries architectonics in superficial and deep plexus.
The study showed high informativity of OCT-A in diagnosis of type 2 idiopathic macular telangiectasia. The main advantage of the method is the possibility to estimate the blood vessels in different levels that is not feasible by means of fluorescein angiography. SOCT and OCT-A allows to make correct diagnosis and to determine proper treatment tactics for the disease. The use of OCT-A is most preferably because the examination is noninvasive and more informative than fluorescein angiography.