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Nadim Choudhury, Nikhil Menon, Alexander Gan, Moataz M Razeen, Alexander Pinhas, Nishit Shah, Ronald C Gentile, Toco Yuen Ping Chui, Alfredo Dubra, Richard B Rosen; In vivo imaging of human retinal microvasculature in sickle cell retinopathy using adaptive optics scanning light ophthalmoscope fluorescein angiography and offset pinhole imaging.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5949.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To detect and monitor microvascular changes cross-sectionally and longitudinally in patients with sickle cell retinopathy (SCR) using adaptive optics scanning light ophthalmoscope (AOSLO) fluorescein angiography (FA) and offset pinhole (OP) imaging.
The maculae of 7 patients (mean age 39, range 23-56) and 25 control subjects (mean age 27, range 21-54) were imaged using AOSLO FA and OP. AOSLO FA images were montaged to create a 6x6 degree perfusion map; OP images created a structural map of the vessels both perfused and non-perfused. In 2 subjects, longitudinal imaging was performed 2 and 3 times, respectively, with 6-8 months between sessions to assess vasculopathic changes over time. Quantitative analysis including vessel density and capillary tortuosity index (TI) within 100 µm of the foveal avascular zone (FAZ) margin, FAZ area and perimeter, and perifoveal intercapillary width (PICW) were quantified using custom MATLAB programs.
All patients showed multiple vasculopathic features including microaneurysms, non-perfused vessels, vessel looping, and tortuous vessels. The SCR group had significantly larger FAZ area and perimeter than the controls. While mean vessel density was found to be lower in the SCR group compared to healthy controls, this difference was not significant (mean 32.54±5.83 vs. 33.40±3.71 mm-1, df=30, p=0.63). PICW was significantly larger in SCR (93±21 vs 77±10µm, df=30, p=0.01). The mean TI in SCR patients was significantly higher than that of controls (1.56±0.61 vs. 1.17±0.09, df=30, p=0.003). Quadrant analysis for TI yielded statistically significant differences in all quadrants except the superior between SCR and controls. Longitudinal imaging in SCR patients revealed vascular changes that included recanalization, vessel loop formation and remodeling in a span of 6-8 months.
AOSLO FA and OP revealed microvascular changes both cross-sectionally and longitudinally. Quantitative measures including TI within 100 microns and PICW may be useful in future studies to monitor SCR patients.
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