ABNORMAL VASCULAR COMPLEX WITHIN AN IDIOPATHIC EPIRETINAL MEMBRANE IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PURPOSE: To report the case 70-year-old patient presenting with preretinal, abnormal vascularization accompanying an idiopathic epiretinal membrane (ERM), identified by optical coherence tomography angiography. METHODS: Observational case report of one patient. RESULTS: The authors describe the case of a patient presenting with an ERM on the right eye since March 2011, diagnosed by fundus biomicroscopy and spectral domain optical coherence tomography (Spectralis; Heidelberg Engineering, Heidelberg, Germany). At the last follow-up visit, the patient had a Snellen best-corrected visual acuity of 20/32 in her right eye and 20/20 in her left eye. Although on spectral domain optical coherence tomography the aspect on the right eye was unchanged since prior examination, optical coherence tomography angiography (Angiovue; Optovue, Fremont, CA) was able to reveal a high-flow, abnormal vascular network in the preretinal manual segmentation corresponding to the ERM. CONCLUSION: Spectral domain optical coherence tomography, routinely performed in these patients, may underestimate the presence of abnormal vascularization, as both preretinal neovascular complexes and thick ERMs appear as hyperreflective structures. Optical coherence tomography angiography allows a fast and depth-resolved visualization of these abnormal vascular complexes inside idiopathic ERMs. Diagnosis of a vascularized epiretinal structure could be noteworthy before decision of retinal surgery.

Nascent Type 3 Neovascularization in Age-Related Macular Degeneration.

PURPOSE: To describe the preclinical and very early stages of type 3 neovascularization using multimodal retinal imaging to expand our understanding of the pathogenesis of this disorder and potentially to prevent late treatment. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients diagnosed with treatment-naïve type 3 neovascularization in the setting of age-related macular degeneration were identified at 4 retina referral centers. Inclusion criteria were: patients older than 55 years with at least 1 OCT and OCT angiography (OCTA) examination before the onset of clinically active type 3 neovascularization (i.e., preclinical stage). METHODS: Patients underwent a complete ophthalmologic examination including at least OCT and OCTA at the baseline and preclinical stage examinations, and dye angiographies when available. Demographics and clinical findings were analyzed. MAIN OUTCOME MEASURES: Description of multimodal imaging features of nascent type 3 neovascularization. RESULTS: Fifteen eyes (15 patients; mean age, 83 ± 9 years) were included. At the baseline, mean BCVA was 0.32 ± 0.17 logarithm of the minimum angle of resolution and central macular thickness was 313 ± 50 µm. Preclinical (i.e., prebaseline) structural OCT illustrated the presence of intraretinal hyperreflective foci (HRF) at the site of type 3 neovascularization development in all patients. These foci were characterized by hyperfluorescence on dye angiography and by detectable flow on OCTA, identified with either the avascular slab (20%) or with both the deep retinal capillary plexus (DCP) and avascular slabs (80%). Typically, HRF with detectable flow on OCTA were characterized by the absence of intraretinal exudation (or very mild microcystic changes) until the lesion progressed from the DCP into the retinal pigment epithelium (RPE) and sub-RPE space. Of note, in 1 patient we observed the complete resolution of HRF despite the presence of OCTA flow and dye angiography hyperfluorescence detected at the preclinical stage examination. CONCLUSIONS: Hyperreflective foci on structural OCT may represent early intraretinal neovascularization originating from the DCP, namely nascent type 3 neovascularization; these lesions can progress to active type 3 neovascularization or more rarely may regress without functional impairment. An advanced multimodal imaging approach is useful in detecting nascent type 3 lesions, which should be followed up carefully and treated as soon as possible if flow progresses to the RPE and sub-RPE space to prevent progression to late stages.

Evaluation of pseudophakic cystoid macular edema using optical coherence tomography angiography.

PURPOSE: To compare the optical coherence tomography angiography (OCT-A) findings of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in eyes with pseudophakic cystoid macular edema (PCME) with those of fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) and to compare PCME vascular density values of the SCP and DCP with those of healthy eyes. METHODS: In this retrospective observational study, 13 eyes (12 patients) with PCME underwent comprehensive ophthalmologic examinations including visual acuity, FA, SD-OCT, and OCT-A. The vascular density of the SCP and DCP were measured using AngioAnalytics software in all PCME eyes and compared with 46 healthy eyes of 25 subjects. RESULTS: In patients with PCME, at the level of SCP, the mean vascular density in the whole en face image was 44.48 ± 3.61% while it was 50.27 ± 5.30% at the level of the DCP. In contrast, the vascular density in the whole en face image was 50.35 ± 3.22 at the level of SCP while it was 56.15 ± 3.28 at the level of DCP in 46 healthy eyes of 25 subjects. The vascular density of patients with PCME was significantly lower than in healthy subjects at the SCP (p<0.0001) and at the DCP (p<0.0001). CONCLUSION: We report the OCT-A appearance of PCME and vascular density map with values that can be easily interpreted for quantitative evaluation of retina perfusion status using OCT-A. This approach might be the first step in helping us fully understand the pathophysiologic mechanisms underlying PCME.