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Pakinee Pooprasert, Philip Wright, Hagar Khalid, Thomas Moloney, Catherine A Egan, Pearse Andrew Keane; Optical Coherence Tomography Angiography for Evaluation of Foveal Neovascularization, a Case Series. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4447.
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Retinal neovascularization is pathognomonic of proliferative diabetic retinopathy (PDR) and most commonly seen near major nasal and temporal vessels or around the optic nerve head. Foveal neovascularization (NV) is rare and its pathophysiology remains largely unknown. In this case series, we report four cases of foveal NV detected and evaluated using optical coherence tomography angiography (OCTA).
This is a retrospective study of patients diagnosed with foveal NV at Moorfields Eye Hospital. All patients underwent OCTA. Patient demographics and clinical data were collected. OCT B-scan were analysed for any preretinal hyperreflective material (PRHM) and the flow signals was documented from OCTA B-scan. OCTA enface was evaluated for the presence of any abnormal vessels at the fovea at the level of the choriocapillaries and the vitreoretinal interface slabs.
Our case series included four male patients (three type 1 diabetic and one type 2 diabetic). The mean age at time of diagnosis was 36.75 years. The patient’s visual acuity ranged from 80-85 ETDRS letters. All except one patient was referred as high risk PDR. For the singular patient who had non-proliferative diabetic retinopathy, the detection of foveal NV was the only proliferative change noted. Clinical examination and color fundus photography could not detect the foveal NV. Fluorescein angiography revealed peripheral non perfusion in all case and late leak at the macula suggesting a diagnosis of focal edema which was not proven by OCT B-scan. PRHM has been detected in all cases on OCT-B scan, and demonstrated flow signals on the OCTA B-scan. Enface OCTA demonstrated abnormal vessels in the fovea on superficial and vitreoretinal interface slabs in the four cases. The foveal avascular zone was normal in two of the patients, and was slightly enlarged in one patient, while extensive macular ischemia was detected in the patient with bilateral foveal NV.
With the use of OCTA, we were able to detect foveal NV which was otherwise missed on FA and evaluate peripheral and macular perfusion
This is a 2020 ARVO Annual Meeting abstract.
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