June 2020
Volume 61, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2020
Dynamics of Microvascular Intermittent Flow in Sickle Cell Retinopathy Revealed by Serial OCT-Angiography
Author Affiliations & Notes
  • Davis B. Zhou
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Winchester, Massachusetts, United States
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Maria V. Castanos
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Winchester, Massachusetts, United States
  • Alexander Pinhas
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Winchester, Massachusetts, United States
  • Peter Gillette
    Medicine, Kings County Hospital Center, Brooklyn, New York, United States
  • Jeffrey Glassberg
    Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Justin V Migacz
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Winchester, Massachusetts, United States
  • Richard B Rosen
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Winchester, Massachusetts, United States
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Toco Yuen Ping Chui
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Winchester, Massachusetts, United States
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Footnotes
    Commercial Relationships   Davis Zhou, None; Maria Castanos, None; Alexander Pinhas, None; Peter Gillette, None; Jeffrey Glassberg, None; Justin Migacz, None; Richard Rosen, Astellas (C), Bayer (C), Boehringer-Ingelheim (C), Genentech-Roche (C), GlaucoHealth (I), Guardion (I), NanoRetina (C), OD-OS (C), Opticology (I), OptoVue (C), OptoVue (P), Regeneron (C), Teva (C); Toco Chui, None
  • Footnotes
    Support  NH Grant EY027301
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 4806. doi:
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      Davis B. Zhou, Maria V. Castanos, Alexander Pinhas, Peter Gillette, Jeffrey Glassberg, Justin V Migacz, Richard B Rosen, Toco Yuen Ping Chui; Dynamics of Microvascular Intermittent Flow in Sickle Cell Retinopathy Revealed by Serial OCT-Angiography. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4806.

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

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Abstract

Purpose : Pathophysiology of sickle cell retinopathy (SCR) involves transient occlusion of microcirculatory networks that precipitate ischemic damage. We assessed these perfusion changes between a baseline imaging session and a 1-hour follow-up in SCR patients compared to controls.

Methods : Seven controls and 9 SCR patients were imaged at two sessions 1-hour apart using an SD-OCT system (Avant RTVue-XR; Optovue). Ten 3x3mm OCT-A scans centered at the fovea were obtained at each session. Scans were registered per subject and averaged per session using ImageJ (PMID:28068370). Analysis was conducted on a full vascular slab. Within-session intermittent flow during the first session was qualitatively identified, defined as capillaries with perfusion in one scan and without perfusion during a subsequent or prior scan.
Between-session changes were measured by calculating the difference in capillary perfusion pixel intensity between sessions for controls (Fig. A & B). Bland-Altman analysis generated a normative variation of pixel intensity between sessions. Difference in perfusion pixel intensity of SCR patients was subsequently calculated. Between-session changes in SCR patients were determined using the normative variation, with regions of non-perfusion defined as change < 0.01st percentile and re-perfusion as change > the 99.99th percentile (Fig. C).

Results : Within-session intermittent flow surrounding the FAZ was seen in 2 of 7 controls and in all 9 SCR patients. Between-session capillary perfusion changes of the entire scan area showed a median (IQR) of 0.49% (0.17-0.82) in SCR, with similar levels of non-perfusion: 0.26% (0.06-0.42) and re-perfusion: 0.23% (0.07-0.37). Greater capillary perfusion alterations were seen in patients with HbSS: 0.82% (0.49-0.83) compared to HbSC: 0.11% (0.08-0.14) and sickle cell trait: 0.59%. Statistical significance was found between HbSS and HbSC on two-tailed Wilcoxon rank sum test (P=0.0357).

Conclusions : Serial OCT-A reveals intermittent flow and capillary perfusion change in retinal microvasculature for SCR patients without intervention. Increased intermittent flow in HbSS compared to HbSC is also consistent with increased systemic vaso-occlusive symptoms documented for the former. Further assessment may reveal alteration of intermittent flow in response to disease progression or pharmacological intervention.

This is a 2020 ARVO Annual Meeting abstract.

 

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