Optical coherence tomography based microangiography as a non-invasive imaging modality for early detection of choroido-neovascular membrane in choroidal rupture

Abstract

Introduction: To evaluate and identify early microvascular changes in patient with choroidal rupture using optical coherence tomography (OCT) based microangiography (OMAG).

Case description: One patient (one eye) with confirmed diagnosis of choroidal rupture after sustained ocular blunt trauma underwent OMAG imaging. OMAG was performed by Zeiss spectral domain OCT-angiography prototype using a "6.5 mm × 6.5 mm" field of view around macular region. The resulting images were presented into bilayers: the retinal layer and the choroidal layer.

Discussion and evaluation: Choroidal rupture sites were easily shown on OMAG images with clear evidence of multiple breaks in Bruch's membrane involving macula and the region superior to nerve. OMAG provided detailed vascular network patterns in the areas of choroidal rupture, showing a concern for choroidal neovascularization (CNV). The OMAG demonstrated cross sectional area to visualize CNV location relative to the other layers of the retina, identifying functional blood vessels through the lesion. The patient's progress was followed using OMAG.

Conclusion: The images provided by OMAG give detailed microvascular findings about the macula and adjacent retinal region along with the underlying choroidal alternations. In our case, details of the architecture and vascular flow of CNVM in choroidal rupture was delivered by OMAG, which were used to follow the progression of the disease progression. Further studies are needed to assess the role of quantitative and qualitative OCT microangiography in the evaluation and treatment of choroidal rupture.

Fig. 1

Color fundus photos of the right eye at presentation and OMAG image scan of the retina. a, d, h, l Show serial color fundus photos of the right eye, in progression postoperative month (POM) # 0, 1, 2 and 4, respectively. As the time elapses, there is visible clearing of the submacular hemorrhage s/p pneumatic displacement, however no obvious evidence of neovascular proliferation or gray subretinal tissue. b, c, e–g, i–k, m–o Show their respective OMAG image scans of approximately 6.5 × 6.5 mm² in the macular region from the right eye. These images represented retinal microvasculature’s, presented in enface projection format, demonstrating the structural and microvascular information from the macula. Note that neovascular OMAG images were resulted from enface projecting the flow signals between RPE and Bruch’s membrane in which no blood vessels should be present in normal eyes

Fig. 2

Heidelberg Spectralis OCT of POM 4 was done to evaluate the architecture of the retina and choroid and it shows the alteration of the retinal–choroidal structures in this case. The OCT image shows the disruption of the RPE layer with underlying Bruch’s membrane

Fig. 3

illustrates the cross sectional OCT at the level of the choroidal rupture with concern for CNVM. Shown on the left are the corresponding enface OMAG vascular maps resulted from projecting the flow signals between RPE and Bruch’s membrane, showing the neo-vessels near the rupture sites. The blood flow is color coded (representing depth) that overlays onto retinal structures. a Illustrated new NV flow that is represented in blue. b The NV flow diminishes in size and in c is faint residual flow through the regressed vessels