Session Title: Imaging II
Session Date/Time: Friday 18/09/2015 | 16:30-18:00
Paper Time: 17:18
First Author: : M.Raimundo PORTUGAL
Co Author(s): : C. Farinha A. Silva M. Cachulo I. Pires J. Figueira R. Silva
PURPOSE:To evaluate qualitative changes in the central macular microvascular network in macular telangiectasia type 1 and 2 (MacTel 1 and 2) using optical coherence tomographic angiography (OCTA) and other conventional imaging modalities.
Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Association for Innovation and Biomedical Research on Light and Image (Aibili), Coimbra, Portugal. Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
We evaluated 8 eyes of seven MacTel1 patients and 11 eyes of six MacTel2 patients using RTVue XR Avanti (Optovue Inc) to obtain optical coherence tomographic angiography images using the split-spectrum amplitude decorrelation algorithm. We also used spectral-domain optical coherence tomography (SD-OCT) to evaluate related structural abnormalities in all patients. Finally, in select patients, we complemented these studies with fundus photography and fluorescein angiography (FA) in order to match and compare qualitative information between these different imaging modalities.
In the MacTel1 group (age of 62.0 ± 12.8 years; 71.4% male; bilateral in one patient), OCTA showed superficial and deep juxtafoveal microaneurysms in 37.5% and 50.0% of eyes, respectively, with superficial and deep microvasculature dilation in 50% and 62.5%, respectively. SD-OCT revealed cystoid macular edema in 25.0%. FA demonstrated telangiectatic vessels in all eyes with hyperfluorescence and leakage in 62.5%. Color fundus photography demonstrated telangiectatic/aneurysmatic vessels with variable occurrence of hard exudates. In the MacTel2 group (age of 57.2 ± 3.8 years; 66.7% female; bilateral in 83.3%), OCTA revealed major alterations in the deep retinal plexus, with predominantly temporal juxtafoveal microvasculature dilation in 90.9% of eyes, decreased vascular density with a coarse branching pattern in 45.5%, increased intervascular spaces in 63.6%, and retinal-retinal anastomoses in 72.7%. The superficial plexus was similarly involved, albeit to a lesser degree. Choriocapillaris alterations were identified in 36.4%. SD-OCT showed RPE and ellipsoid involvement (81.8%), hyporeflective cavities (72.7%), plaques of intraretinal pigment (36.4%), macular atrophy (63.6%), and evidence of choroidal neovascularization in 18.2% (2 eyes). FA and color fundus photography were characteristic of MacTel 2.
We found a consistent set of alterations in the juxtafoveal macular microvasculature using OCTA in both MacTel1 and 2, matched to abnormalities in other imaging modalities, specifically invasive fluorescein angiography. Deep capillary plexus involvement seems to play a dominant role in MacTel2, while other features, namely choroidal neovascularization, are likely related to disease progression. In our MacTel1 group, OCTA, though informative, did not show a clear-cut tropism to either retinal vascular plexi. OCTA is an emerging technique that combined with standard structural information from SD-OCT constitutes a powerful non-invasive tool in evaluating these distinct and rare pathological entities.