Andreas Berlin1,2, Diogo Cabral3,4, Ling Chen1,5, Jeffrey D Messinger1, Chandrakumar Balaratnasingam6,7,8, Randev Mendis9, Daniela Ferrara10, K Bailey Freund3,11, Christine A Curcio1. 1. Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham. 2. University Hospital Würzburg, Würzburg, Germany. 3. Vitreous Retina Macula Consultants of New York, New York. 4. CEDOC-NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal. 5. The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China. 6. Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia. 7. Lions Eye Institute, Nedlands, Western Australia, Australia. 8. Department of Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. 9. Canberra Retina Center, Canberra, Australia. 10. Genentech, San Francisco, California. 11. Department of Ophthalmology, New York University Grossman School of Medicine, New York.
Abstract
Importance: By validating optical coherence tomography angiography (OCTA) in the analysis of type 3 macular neovascularization secondary to age-related macular degeneration, the overall value of clinical OCTA for disease observation, diagnosis, and staging is increased. Objective: To assess the association of in vivo OCTA of type 3 macular neovascularization secondary to age-related macular degeneration with corresponding ex vivo histology. Design, Setting, and Participants: This study included clinical imaging, laboratory microscopy, and eye-tracked clinicopathologic correlation of a single case from a community-based practice evaluated at a university-based research laboratory from 2014 to 2019. Exposures: Infrared reflectance and eye-tracked spectral-domain OCTA clinical imaging was correlated with ex vivo high-resolution histologic images of the preserved donor eye. Eye tracking, applied to the donor eye, enabled identification of histologic features corresponding with clinical OCTA signatures. Projection artifact removal based on 2-dimensional vessel-shape estimation and a Gaussian blur filter demonstrated a robust preservation of neovascular flow signal. Main Outcomes and Measures: Histology findings associated with clinical OCTA signatures. Three-dimensional view of neovascularization via video. Results: A White woman in her 90s with type 3 neovascularization secondary to age-related macular degeneration was treated with 37 intravitreal injections of ranibizumab and aflibercept in the right eye. The index lesion displayed a drusenoid pigment epithelium detachment, characteristic of type 3 neovascularization. OCTA decorrelation signal in the index lesion corresponded in histology to a collagen-ensheathed vascular complex contacting basal laminar deposit that outlasted the retinal pigment epithelium. The subretinal pigment epithelium-basal laminar space contained calcified material and glial processes. No connection between the choriocapillaris and this space was observed. Video showed a columnar tangle of flow signal in the outer nuclear layer, with inflow and outflow vessels connecting to the superficial artery and vein. Conclusions and Relevance: While this study presents only 1 case in which a vascular connection between subretinal pigment epithelium-basal laminar space and choriocapillaris was undetected, these results support the potential value of OCTA for diagnosis. OCTA decorrelation signal of type 3 neovascularization corresponded with intraretinal neovessels on histology. Projection artifact removal based on 2-dimensional vessel-shape estimation and Gaussian blur filter demonstrated their potential value for further use in OCTA decorrelation signal processing.
Importance: By validating optical coherence tomography angiography (OCTA) in the analysis of type 3 macular neovascularization secondary to age-related macular degeneration, the overall value of clinical OCTA for disease observation, diagnosis, and staging is increased. Objective: To assess the association of in vivo OCTA of type 3 macular neovascularization secondary to age-related macular degeneration with corresponding ex vivo histology. Design, Setting, and Participants: This study included clinical imaging, laboratory microscopy, and eye-tracked clinicopathologic correlation of a single case from a community-based practice evaluated at a university-based research laboratory from 2014 to 2019. Exposures: Infrared reflectance and eye-tracked spectral-domain OCTA clinical imaging was correlated with ex vivo high-resolution histologic images of the preserved donor eye. Eye tracking, applied to the donor eye, enabled identification of histologic features corresponding with clinical OCTA signatures. Projection artifact removal based on 2-dimensional vessel-shape estimation and a Gaussian blur filter demonstrated a robust preservation of neovascular flow signal. Main Outcomes and Measures: Histology findings associated with clinical OCTA signatures. Three-dimensional view of neovascularization via video. Results: A White woman in her 90s with type 3 neovascularization secondary to age-related macular degeneration was treated with 37 intravitreal injections of ranibizumab and aflibercept in the right eye. The index lesion displayed a drusenoid pigment epithelium detachment, characteristic of type 3 neovascularization. OCTA decorrelation signal in the index lesion corresponded in histology to a collagen-ensheathed vascular complex contacting basal laminar deposit that outlasted the retinal pigment epithelium. The subretinal pigment epithelium-basal laminar space contained calcified material and glial processes. No connection between the choriocapillaris and this space was observed. Video showed a columnar tangle of flow signal in the outer nuclear layer, with inflow and outflow vessels connecting to the superficial artery and vein. Conclusions and Relevance: While this study presents only 1 case in which a vascular connection between subretinal pigment epithelium-basal laminar space and choriocapillaris was undetected, these results support the potential value of OCTA for diagnosis. OCTA decorrelation signal of type 3 neovascularization corresponded with intraretinal neovessels on histology. Projection artifact removal based on 2-dimensional vessel-shape estimation and Gaussian blur filter demonstrated their potential value for further use in OCTA decorrelation signal processing.
Authors: Xiaoyu Xu; Nicolas A Yannuzzi; Pedro Fernández-Avellaneda; Jose J Echegaray; Kimberly D Tran; Jonathan F Russell; Nimesh A Patel; Rehan M Hussain; David Sarraf; K Bailey Freund Journal: Am J Ophthalmol Date: 2019-06-19 Impact factor: 5.258
Authors: Chandrakumar Balaratnasingam; Jeffrey D Messinger; Kenneth R Sloan; Lawrence A Yannuzzi; K Bailey Freund; Christine A Curcio Journal: Ophthalmology Date: 2017-01-30 Impact factor: 12.079
Authors: Robyn H Guymer; Philip J Rosenfeld; Christine A Curcio; Frank G Holz; Giovanni Staurenghi; K Bailey Freund; Steffen Schmitz-Valckenberg; Janet Sparrow; Richard F Spaide; Adnan Tufail; Usha Chakravarthy; Glenn J Jaffe; Karl Csaky; David Sarraf; Jordi M Monés; Ramin Tadayoni; Juan Grunwald; Ferdinando Bottoni; Sandra Liakopoulos; Daniel Pauleikhoff; Sergio Pagliarini; Emily Y Chew; Francesco Viola; Monika Fleckenstein; Barbara A Blodi; Tock Han Lim; Victor Chong; Jerry Lutty; Alan C Bird; Srinivas R Sadda Journal: Ophthalmology Date: 2019-09-30 Impact factor: 12.079
Authors: Anna C S Tan; Polina Astroz; Kunal K Dansingani; Jason S Slakter; Lawrence A Yannuzzi; Christine A Curcio; K Bailey Freund Journal: Invest Ophthalmol Vis Sci Date: 2017-04-01 Impact factor: 4.799