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Steven T Bailey, Yali Jia, Christina J Flaxel, Ou Tan, Thomas S Hwang, Andreas K Lauer, David J Wilson, Joachim Hornegger, James G Fujimoto, David Huang; Improved visualization of choroidal neovascularization in age-related macular degeneration with optical coherence tomography angiography compared to fluorescein angiography. Invest. Ophthalmol. Vis. Sci. 2014;55(13):255.
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To determine if novel optical coherence tomography (OCT) angiography can improve visualization of ill-defined choroidal neovascularization (CNV) in age-related macular degeneration (AMD) imaged with fluorescein angiography (FA).
Cases of neovascular AMD with ill-defined CNV with FA were defined as either occult CNV or CNV obscured by subretinal hemorrhage (SRH). OCT angiography images were obtained with a prototype high-speed (100K A scan/second) 1050 nm swept-source OCT. Flow was detected using the split-spectrum amplitude-decorrelation angiography (SSADA) algorithm. The volumetric angiogram was segmented between the outer plexiform layer (OPL) and Bruch’s membrane to identify pathologic flow associated with CNV. En face OCT angiogram of both CNV and segmented inner retinal angiogram (internal limiting membrane to OPL) were compared to early and late images obtained with FA. Depth-resolved CNV location was studied by overlaying color-coded flow data with structural OCT.
In a case of occult CNV, OCT angiography demonstrated an easily visualized and well-defined vascular network in the outer retina (CNV) corresponding to a vague area of stippled hyperfluorescence with late leakage on FA. Depth resolved CNV localization with cross-sectional OCT angiograms revealed type I CNV. In a case with SRH, CNV is clearly visible on OCT angiography while it is obscured by the hemorrhage with FA. Cross-sectional OCT angiograms demonstrated type II CNV.
OCT angiography with the SSADA technology improves visualization of CNV tissue in cases ill-defined with conventional FA, including: occult CNV and CNV associated with SRH. Improved visualization of CNV tissue with OCT angiography may enhance CNV detection and help refine individualized treatment strategies.
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