Efficacy of Optical Coherence Tomography Angiography in Measuring the Foveal Avascular Zone Area in Patients with Branch Retinal Vein Occlusion

Lee Seunghwan; Kee Min Jung; Moon Woo Je

doi:10.3341/jkos.2017.58.7.818

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Seunghwan, Jung, and Je: Efficacy of Optical Coherence Tomography Angiography in Measuring the Foveal Avascular Zone Area in Patients with Branch Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2017;58(7):818-827.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.818

Efficacy of Optical Coherence Tomography Angiography in Measuring the Foveal Avascular Zone Area in Patients with Branch Retinal Vein Occlusion

Lee Seunghwan, M.D., Kee Min Jung, M.D., Moon Woo Je, M.D., PhD

Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Address reprint requests to Je Moon Woo, MD, PhD Department of Ophthalmology, Ulsan University Hospital, #877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea Tel: 82-52-250-7177, Fax: 82-52-250-7174 E-mail: limbus68@naver.com

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 23 February 201716 May 2017 Accepted 20 June 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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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Keywords: Branch retinal vein occlusion (BRVO), Fluorescein angiography (FAG), Foveal avascular zone (FAZ), Macular ede-ma (ME), Optical coherence tomography angiography (OCTA)

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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).

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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).

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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).

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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.

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Table 1.

Subject baseline demographic and ocular characteristics

Characteristics	Total subjects	Macular edema		p-value^*
Characteristics	(n = 34)	(-) (n = 16)	(+) (n = 18)	p-value^*
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

Values are presented as mean ± SD unless otherwise indicated. BCVA = best corrected visual acuity; logMAR = logarithm of the minimum angle of resolution; HTN = hypertension; DM = diabetes mellitus.

^* p values derived from Mann-Whitney U-test (Macular edema [-] vs. [+]).

Table 2.

The intraclass correlation coefficient (ICC) was used to determine the interobserver reproducibility for the manually meas ured foveal avascular zone (FAZ)

FAZ area	Enrolled eyes	ICC	p-value
FAG (BRVO)	34	0.880	0.001
SCP in OCTA (BRVO)	34	0.989	0.001
SCP in OCTA (normal)	30	0.958	0.001
DCP in OCTA (BRVO)	34	0.891	0.001
DCP in OCTA (normal)	30	0.841	0.001

Normal area of FAZ was measured in the unaffected fellow eyes. FAG = fluorescein angiography; BRVO = branch retinal vein occlusion; SCP = superficial capillary plexus; OCTA = optical co herence tomography angiography; DCP = deep capillary plexus.

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
FAZ area (mm²)	Normal fellow eyes	(-) (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^†

Values are presented as mean ± SD unless otherwise indicated. SCP = superficial capillary plexus; DCP = deep capillary plexus.

^* p-values derived from Mann-Whitney U-test (macular edema [-] vs. [+]).

^† p-values derived from Kruskal-Wallis tests (normal fellow eyes ver sus macular edema [-] vs. [+]).

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

Comparison (FAZ area)	ICC	p-value
FAG vs. SCP in OCTA	0.916	0.001
FAG vs. SCP in OCTA with ME(-)	0.837	0.001
FAG vs. SCP in OCTA with ME(+)	0.938	0.001
FAG vs. DCP in OCTA	0.001	0.501
FAG vs. DCP in OCTA with ME(-)	0.295	0.256
FAG vs. DCP in OCTA with ME(+)	-0.059	0.547

ICC = intraclass correlation coefficient; SCP = superficial capillary plexus; ME = macular edema; DCP = deep capillary plexus.

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