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Alexander Pinhas, Justin V Migacz, Davis Zhou, Maria Virginia Castanos Toral, Sharon Israel, Vincent Sun, Peter Gillette, Nripun Sredar, Alfredo Dubra, Jeffrey Glassberg, Richard B Rosen, Toco Yuen Ping Chui; Dynamic Visualization of Abnormal Parafoveal Blood Flow in Sickle Cell Patients Using AOSLO Vascular Imaging. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1928.
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© ARVO (1962-2015); The Authors (2016-present)
To use adaptive optics scanning light ophthalmoscopy (AOSLO) dynamic vascular imaging to characterize abnormal OCT angiographic blood flow patterns seen in patients with sickle cell disease.
Ten sequential 3x3 mm parafoveal OCTA full layer scans per eye were obtained utilizing a commercial spectral domain OCT system (Avanti RTVue-XR; Optovue, Fremont, CA), and were used to identify regions of interest (ROIs) with poor perfusion or nonperfusion near the foveal avascular zone (FAZ). AOSLO vascular imaging was performed on these ROIs to characterize dynamic features of abnormal blood flow. AOSLO employed "quad detection" in the nonconfocal channels allowing visualization of contrast at an arbitrary angle, which optimized it for vascular imaging.
We studied 7 eyes of 7 patients (mean age 31, range 23-44; 5 females, 2 males; 4 right eyes, 3 left eyes). Five patients had hemoglobin SS (HbSS) with nonproliferative sickle cell retinopathy (NPSR), of which 3 were on hydroxyurea and folate and 2 were treatment naive. One patient had HbSC with proliferative sickle cell retinopathy (PSR) and 1 patient had sickle cell trait with PSR; both were treatment naive. AOSLO vascular imaging of ROIs identified by OCTA revealed intravascular sludging, stasis and rouleaux formation of red blood cells (RBCs) (Figures 1 and 2). AOSLO vascular imaging was able to image a single sickled cell flowing through a capillary segment. In areas of poor blood flow, the capillary wall on AOSLO often appeared dilated and congested with a lumpy-bumpy contour.
AOSLO vascular imaging revealed that areas of intermittent perfusion and nonperfusion imaged by OCTA were due to abnormal RBC flow. Combining OCTA with AOSLO vascular imaging provided a clearer picture of some of the vascular anomalies of sickle cell disease, and may be useful for characterizing response to emerging therapeutic approaches.
This is a 2020 ARVO Annual Meeting abstract.
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