July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Quantifying Spatial and Temporal Vascular Perfusion Changes Before and After Intravitreal Anti-VEGF Injections in Proliferative Diabetic Retinopathy(PDR)
Author Affiliations & Notes
  • Richard B Rosen
    Ophthalmology, New York Eye & Ear Infirmary, New York, New York, United States
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Jorge Andrade
    Ophthalmology, New York Eye & Ear Infirmary, New York, New York, United States
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Davis B. Zhou
    Ophthalmology, New York Eye & Ear Infirmary, New York, New York, United States
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Maria V. Castanos
    Ophthalmology, New York Eye & Ear Infirmary, New York, New York, United States
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Rishard Weitz
    Ophthalmology, New York Eye & Ear Infirmary, New York, New York, United States
  • Toco Yuen Ping Chui
    Ophthalmology, New York Eye & Ear Infirmary, New York, New York, United States
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Footnotes
    Commercial Relationships   Richard Rosen, Astellas (C), Boehringer Ingelheim (C), Diopsys (C), Genentech (F), Guardion Health (C), NanoRetina (C), OD-OS (C), Opticology (I), Optovue (C), Regeneron (C), Zeavision (F); Jorge Andrade, None; Davis Zhou, None; Maria Castanos, None; Rishard Weitz, CellView (I); Toco Chui, None
  • Footnotes
    Support  National Eye Institute of the National Institutes of Health under award numbers R01EY027301. Additional funding for this research was provided by the Marrus Family Foundation, the Geraldine Violett Foundation and The Edward N. & Della L. Thome Memorial Foundation.
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2807. doi:
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      Richard B Rosen, Jorge Andrade, Davis B. Zhou, Maria V. Castanos, Rishard Weitz, Toco Yuen Ping Chui; Quantifying Spatial and Temporal Vascular Perfusion Changes Before and After Intravitreal Anti-VEGF Injections in Proliferative Diabetic Retinopathy(PDR). Invest. Ophthalmol. Vis. Sci. 2019;60(9):2807.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To assess non-perfusion, re-perfusion, and intermittent flow before and after intravitreal anti-VEGF injections in PDR patients using OCT-A.

Methods : 4 patients with PDR were imaged using a commercial SDOCT system (Avanti RTVue-XR; Optovue). Only 1 patient showed substantial posterior neovascularization (Fig. A). Ten 3x3 mm macular OCT-A images were obtained and averaged (Mo et al., 2017). Full retina slab located between the ILM and OPL +10µm was used for image analysis. OCT-A imaging was performed pre-injection, biweekly folowing injections for one month (2,total) of 1.25Mg Bevacizumab. OCT-A image processing and custom perfusion density computation were performed using MATLAB(Andrade Romo et al 2018) (Fig. A-F). Non-perfusion and re-perfusion were defined as perfusion density differences between visits lower than 0.1% or higher than 99.9% of the normal variation, respectively (Fig. E). Number of capillary segments with intermittent flow identified on the 10 registered OCT-A images and number of microaneurysms identified on the averaged OCT-A image were also recorded at each visit.

Results : Between pre-injection and 2 weeks after injection, non-perfusion and re-perfusion area changes (mean±SDs) were 6.00±9.59% and 2.10±3.16%, respectively. Between pre-injection and 4 weeks after injection, non-perfusion and re-perfusion area changes (mean±SD)were 13.34±17.38% and 2.78±2.35%, respectively. The majority of the non-perfusion over time was attributed to regression of neovascularization in 1 patient. Two capillary segments with intermittent flow were identified at pre-injection and were noted to be constantly perfused after injections. 26 microaneurysms were identified pre-injection with noticeable regression in sizes 2 weeks after injection.

Conclusions : Our findings demonstrate that non-perfusion, re-perfusion, and intermittent flow in proliferative diabetic retinopathy treated with anti-VEGF injections can be identified qualitatively and quantitatively using OCT-A. The clinical application of this approach will require expanded studies

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

OCT-A perfusion density changes in PDR. A-F) before and after anti VEGF injections (2, 4 weeks). G) Perfusion density changes, G) before and 2 weeks after injection, and H) before and 4 weeks after injection. Areas of non-perfusion and re-perfusion (<0.1% or >99.9% of normal) were highlighted in red and cyan.

OCT-A perfusion density changes in PDR. A-F) before and after anti VEGF injections (2, 4 weeks). G) Perfusion density changes, G) before and 2 weeks after injection, and H) before and 4 weeks after injection. Areas of non-perfusion and re-perfusion (<0.1% or >99.9% of normal) were highlighted in red and cyan.

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