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Abstract
Purpose
To evaluate the efficacy of optical coherence tomography angiography (OCTA) by measuring the foveal avascular zone (FAZ) area in patients with branch retinal vein occlusion (BRVO).
Methods
Thirty four eyes of 34 patients with BRVO were retrospectively reviewed. The area of the FAZ was calculated using flu-orescein angiography (FAG) and OCTA. The FAZ area was divided into two groups according to the presence of macular ede-ma, which was determined based on the central foveal thickness (300 μ m), and then the measured areas were compared.
Results
Pearson’s correlation analysis revealed a significant positive correlation between FAG and the superficial capillary plexus (SCP) in OCTA with or without macular edema (r = 0.845, p = 0.001). However, there was not a significant correlation be-tween FAG and the deep capillary plexus (DCP) in OCTA (r = 0.001, p = 0.996). In addition, the FAZ area measured by FAG and OCTA in the SCP showed a significant agreement between the two methods (intraclass correlation coefficient [ICC] = 0.916, p = 0.001). However, there was no significant relation found for the FAZ area between FAG and OCTA in the DCP (ICC = 0.001, p = 0.501).
Conclusions
In the patients with BRVO, OCTA can be used to measure the FAZ areas in both the SCP and DCP, beyond meas-urement of the FAZ area at the two-dimensional cross section used during FAG. The FAZ area in the SCP via OCTA showed a statistically significant correlation with the FAZ area determined by FAG, but there was no such correlation in the DCP. That said, the FAZ area in the DCP was positively correlated with a decrease in visual acuity among the patients, which may be an indicator of visual prognosis.
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Figure 1.
Branch retinal vein occlusion without macular edema. Color fundus photo (A), Fluorescein angiography (FAG; B), Zoom on the fovea in FAG (C), optical coherence tomography angiography (OCTA) in the superficial capillary plexus showed quite nor-mal and well demarcated foveal capillary arcade (D). OCTA in the deep capillary plexus showed dilatation of deep inferior macular capillaries with hyper signal although there was not significant magnified nonperfused area in fovea (E). Optical coherence tomog-raphy showed there was no intraretinal cystic lesion (F).
Figure 2.
Macular edema related to a branch retinal vein occlusion. Color fundus photo (A), Fluorescein angiography (FAG; B), Zoom on the fovea in FAG (C), optical coherence tomography angiography (OCTA) in the superficial capillary plexus showed pret-ty well demarcated foveal capillary arcade although there was disruption of the capillary network superiorly (D). However, OCTA in the deep capillary plexus (DCP) showed central black cysts, disorganization of the deep superior macula and magnified non-perfused area (E). Optical coherence tomography showed multiple intraretinal cysts where the corresponding OCTA in the DCP (F).
Figure 3.
Relationship of foveal avascular zone area measured between fluorescein angiography (FAG) and optical coherence to-mography angiography (OCTA). Pearson’s correlation analysis showed significant positive correlation between FAG and superficial capillary plexus (SCP) in OCTA with or without macular edema (ME) (A: FAG vs. SCP in OCTA, r = 0.845, p = 0.001; B: FAG vs. SCP in OCTA without ME, r = 0.804, p = 0.001; C: FAG vs. SCP in OCTA with ME, r = 0.906, p = 0.001). But, there was not significant correlation between FAG and deep capillary plexus (DCP) in OCTA (D: FAG vs. DCP in OCTA, r = 0.001, p = 0.996; E: FAG vs. DCP in OCTA without ME, r = 0.246, p = 0.359; F: FAG vs. DCP in OCTA with ME, r = 0.106, p = 0.674).
Figure 4.
Relationship of best corrected visual acuity (BCVA; logMAR) and deep capillary plexus (DCP) in optical coherence tomography angiography (OCTA). Pearson's correlation analysis showed significant positive correlation between logMAR and DCP in OCTA (r = 0.724 p = 0.001). logMAR = logarithm of the minimum angle of resolution.
Table 1.
Subject baseline demographic and ocular characteristics
| Characteristics | Total subjects | Macular edema | p-value* | |
|---|---|---|---|---|
| (n = 34) | (-) (n = 16) | (+) (n = 18) | ||
| Age (years) | 60.94 ± 9.75 | 60.56 ± 9.44 | 61.28 ± 10.27 | 0.835 |
| Male/Female | 15/19 | 7/9 | 8/10 | 1.000 |
| BCVA (logMAR) | 0.27 ± 0.35 | 0.22 ± 0.42 | 0.32 ± 0.28 | 0.044 |
| HTN | 16 | 7 | 9 | 0.984 |
| DM | 5 | 1 | 4 | 0.408 |
| Hyperlipidemia | 4 | 2 | 2 | 1.000 |
| Central foveal thickness (μ m) | 327.12 ± 120.98 | 246.38 ± 31.98 | 398.89 ± 122.38 | 0.001 |
Table 2.
The intraclass correlation coefficient (ICC) was used to determine the interobserver reproducibility for the manually meas ured foveal avascular zone (FAZ)
Table 3.
Comparisons of foveal avascular zone (FAZ) areas with fluorescein angiography (FAG) and optical coherence tomography angiography (OCTA) in branch retinal vein occlusion with or without macular edema and normal fellow eyes
| FAZ area (mm2) | Normal fellow eyes | Macular edema | p-value | |
|---|---|---|---|---|
| (-) (n = 16) | (+) (n = 18) | p-value | ||
| FAG | 0.46 ± 0.14 | 0.46 ± 0.12 | 0.863* | |
| SCP in OCTA | 0.39 ± 0.13 | 0.38 ± 0.13 | 0.36 ± 0.13 | 0.547† |
| DCP in OCTA | 1.09 ± 0.23 | 1.20 ± 0.37 | 1.83 ± 0.75 | 0.001† |
Table 4.
Comparison of intraclass correlations of foveal avascular zone (FAZ) area measurements from fluorescein angiography (FAG) and optical coherence tomography angiography (OCTA) in branch retinal vein occlusion patients
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