June 2023
Volume 64, Issue 9
Open Access
ARVO Imaging in the Eye Conference Abstract  |   June 2023
Small retinal ischemic perivascular lesions display quantitative changes on swept source optical coherence tomography angiography
Author Affiliations & Notes
  • Michael Drakopoulos
    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • David L. Zhang
    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Brian Cheng
    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Curtis Heisel
    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Kevin Zhang
    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Arnold Nadel
    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Alessandro Marchese
    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Rukhsana G. Mirza
    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Footnotes
    Commercial Relationships   Michael Drakopoulos, None; David Zhang, None; Brian Cheng, None; Curtis Heisel, None; Kevin Zhang, None; Arnold Nadel, None; Alessandro Marchese, None; Rukhsana Mirza, None
  • Footnotes
    Support  Grant from the Illinois Society for the Prevention of Blindness; unrestricted departmental grant from Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2023, Vol.64, PB0053. doi:
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      Michael Drakopoulos, David L. Zhang, Brian Cheng, Curtis Heisel, Kevin Zhang, Arnold Nadel, Alessandro Marchese, Rukhsana G. Mirza; Small retinal ischemic perivascular lesions display quantitative changes on swept source optical coherence tomography angiography. Invest. Ophthalmol. Vis. Sci. 2023;64(9):PB0053.

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

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Abstract

Purpose : Small middle macular ischemic lesions dubbed “retinal ischemic perivascular lesions” (RIPLs) are some of the smallest lesions associated with the retinal ischemic cascade and have recently been associated with cardiovascular disease. It has been reported that such lesions quantitatively alter the retinal microvasculature only when their diameter exceeds 300µm. We investigated microvascular changes associated with RIPLs smaller than this diameter with a retrospective, cross-sectional, observational clinical study of the vessel linear density (VLD) of the superficial (SCP) and deep (DCP) capillary plexuses.

Methods : Patients aged 18-95 years old received voluntary PLEX Elite 9000 SS-OCTA imaging between 9/2021 and 1/2023. The database of these images was searched for all patients with carotid artery stenosis or dry AMD and for healthy controls. 6mm x 6mm macular SS-OCTA scans of each dilated eye were analyzed. RIPLs were manually identified in b-scans by five graders with a sixth arbitrating. One grader measured the largest diameter of each RIPL on b-scans with FIJI. Manufacturer’s standard software was used to generate en face SCP and DCP projections. Circles concentric with each RIPL with diameters 1x and 3x the diameter of the RIPL for all RIPLs were analyzed with FIJI and Python to yield VLD within the smaller circle ("local” VLD) and between the circles (“regional” VLD). VLD was also calculated for the entire 6mm x 6mm scan (“global” VLD). “Small” RIPLs were defined as those under the 20th percentile of diameter (180µm) with all others considered “large”. Differences between local, regional, and global VLD of the SCP and DCP were analyzed with t-tests for small and large RIPLs.

Results : 106 eyes of 53 patients (31 female) met inclusion and exclusion criteria. At least 1 RIPL was found in 43 of 53 patients (61 of 106 eyes). Mean age was 69.8 years. SCP VLD was no different locally vs regionally or regionally vs globally for both small and large RIPLs (all p>0.10). DCP VLD was reduced locally vs regionally for both small and large RIPLs (both p<0.001).

Conclusions : RIPLs are associated with local decreases in VLD in the DCP but not the SCP regardless of RIPL size. Mild middle retinal ischemia quantifiably alters the DCP without altering the SCP, even in lesions less than 300 µm wide.

This abstract was presented at the 2023 ARVO Imaging in the Eye Conference, held in New Orleans, LA, April 21-22, 2023.

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