Amir H Kashani1, Kyle M Green1, Julie Kwon1, Zhongdi Chu2, Qinqin Zhang2, Ruikang K Wang2,3, Sean Garrity4, David Sarraf4, Carl B Rebhun5, Nadia K Waheed5, Karen B Schaal6, Marion R Munk6,7, Sarra Gattoussi8, K Bailey Freund8, Fang Zheng9, Guanghui Liu9, Philip J Rosenfeld9. 1. USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California. 2. Department of Bioengineering, University of Washington, Seattle, Washington. 3. Department of Ophthalmology, University of Washington, Seattle, Washington. 4. Stein Eye Institute, University of California, Los Angeles, Los Angeles, California. 5. New England Eye Center/Tufts University School of Medicine, Boston, Massachusetts. 6. Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland. 7. Bern Photographic Reading Center, Inselspital, University Clinic Bern, Bern, Switzerland. 8. Vitreous Retina Macula Consultants of New York, New York. 9. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Abstract
OBJECTIVE: To characterize features of extra-vascular optical coherence tomography angiography (OCTA) signals corresponding to hyperreflective intraretinal fluid across various exudative maculopathies. DESIGN: Multicenter, retrospective, observational study. PARTICIPANTS: Eyes with various forms of exudative maculopathy including diabetic retinopathy (DR), retinal vein occlusion (RVO), and neovascular-age related macular degeneration (nvAMD). METHODS: Patients with extra-vascular OCTA signal identified on en face OCTA images were included in this study. This signal was readily distinguishable from projection artifacts. The regions with the extra-vascular motion signal on OCTA were named "Suspended Scattering Particles in Motion (SSPiM)." Depth-encoded, color, en face OCTA images (3mm × 3mm) centered on the fovea and their corresponding structural OCT scans were used to quantify features of SSPiM and its corresponding hyperreflective fluid. Longitudinal data were collected when available. MAIN OUTCOME MEASURES: Anatomic location, the association with hyperreflective material, changes in location and appearance of SSPiM over time, and replication of SSPiM OCTA signal in an in vitro phantom. RESULTS: Seventy-six eyes in 62 patients with various forms of exudative maculopathy were evaluated; 60 eyes with DR, 9 eyes with RVO, and 5 eyes nvAMD, 1 eye with macroaneurysm, and 1 eye with radiation retinopathy. Intraretinal accumulations of fluid with increased OCT signal intensity corresponded to regions of SSPiM in several exudative maculopathies. An in vitro phantom model demonstrates that particulate matter in suspension can generate similar OCTA signal. SSPiM showed an anatomic preference for vascular-avascular junctions. The hyperreflective fluid corresponding to SSPiM appeared more frequently in Henle's fiber layer (HFL) than the inner nuclear layer (INL) and was highly associated with hyperreflective material (HRM) found bordering the fluid. In five of eight longitudinal cases, the resolution of SSPiM resulted in the formation of confluent HRM. Clinically, this appeared as hard exudate on funduscopic images. CONCLUSIONS: Clinical data suggest that SSPiM is a novel imaging feature of retinal vascular diseases that was not appreciated prior to the use of OCTA. We characterized several novel features of SSPiM and demonstrated that at least in some cases it resolves with residual hard exudate.
OBJECTIVE: To characterize features of extra-vascular optical coherence tomography angiography (OCTA) signals corresponding to hyperreflective intraretinal fluid across various exudative maculopathies. DESIGN: Multicenter, retrospective, observational study. PARTICIPANTS: Eyes with various forms of exudative maculopathy including diabetic retinopathy (DR), retinal vein occlusion (RVO), and neovascular-age related macular degeneration (nvAMD). METHODS: Patients with extra-vascular OCTA signal identified on en face OCTA images were included in this study. This signal was readily distinguishable from projection artifacts. The regions with the extra-vascular motion signal on OCTA were named "Suspended Scattering Particles in Motion (SSPiM)." Depth-encoded, color, en face OCTA images (3mm × 3mm) centered on the fovea and their corresponding structural OCT scans were used to quantify features of SSPiM and its corresponding hyperreflective fluid. Longitudinal data were collected when available. MAIN OUTCOME MEASURES: Anatomic location, the association with hyperreflective material, changes in location and appearance of SSPiM over time, and replication of SSPiM OCTA signal in an in vitro phantom. RESULTS: Seventy-six eyes in 62 patients with various forms of exudative maculopathy were evaluated; 60 eyes with DR, 9 eyes with RVO, and 5 eyes nvAMD, 1 eye with macroaneurysm, and 1 eye with radiation retinopathy. Intraretinal accumulations of fluid with increased OCT signal intensity corresponded to regions of SSPiM in several exudative maculopathies. An in vitro phantom model demonstrates that particulate matter in suspension can generate similar OCTA signal. SSPiM showed an anatomic preference for vascular-avascular junctions. The hyperreflective fluid corresponding to SSPiM appeared more frequently in Henle's fiber layer (HFL) than the inner nuclear layer (INL) and was highly associated with hyperreflective material (HRM) found bordering the fluid. In five of eight longitudinal cases, the resolution of SSPiM resulted in the formation of confluent HRM. Clinically, this appeared as hard exudate on funduscopic images. CONCLUSIONS: Clinical data suggest that SSPiM is a novel imaging feature of retinal vascular diseases that was not appreciated prior to the use of OCTA. We characterized several novel features of SSPiM and demonstrated that at least in some cases it resolves with residual hard exudate.
Authors: Amir H Kashani; Chieh-Li Chen; Jin K Gahm; Fang Zheng; Grace M Richter; Philip J Rosenfeld; Yonggang Shi; Ruikang K Wang Journal: Prog Retin Eye Res Date: 2017-07-29 Impact factor: 21.198
Authors: Vita L S Dingerkus; Marion R Munk; Max P Brinkmann; Florentina J Freiberg; Florian M A Heussen; Stephan Kinzl; Sandra Lortz; Selim Orgül; Matthias Becker Journal: J Ophthalmic Inflamm Infect Date: 2019-05-28
Authors: Kirk K Hou; Adrian Au; Amir H Kashani; K Bailey Freund; Srinivas R Sadda; David Sarraf Journal: Transl Vis Sci Technol Date: 2019-06-27 Impact factor: 3.283
Authors: Riccardo Sacconi; Gerard A Lutty; Robert F Mullins; Enrico Borrelli; Francesco Bandello; Giuseppe Querques Journal: Am J Ophthalmol Case Rep Date: 2019-11-07