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Comparative Study
. 2019 Jun 4;14(6):e0217849.
doi: 10.1371/journal.pone.0217849. eCollection 2019.

Comparison of foveal avascular zone between optical coherence tomography angiography and fluorescein angiography in patients with retinal vein occlusion

Jens Ulrich Werner  1 , Felix Böhm  2 , Gabriele E Lang  1 , Jens Dreyhaupt  3 , Gerhard K Lang  1 , Christian Enders  1
Affiliations
Comparative Study

Comparison of foveal avascular zone between optical coherence tomography angiography and fluorescein angiography in patients with retinal vein occlusion

Jens Ulrich Werner et al. PLoS One. .

Abstract

Objective: To compare area of foveal avascular zone (FAZ) in different retinal vascular layers in optical coherence tomography angiography (OCTA) and fluorescein angiography (FA) in patients with retinal vein occlusion (RVO).

Design and methods: Prospective cross-sectional comparative study in 47 eyes of 47 patients. FA was recorded with the Zeiss FF450plusIR camera and OCTA was obtained with the Zeiss Cirrus 5000 equipped with the AngioPlex module. Area of FAZ was graded by two independent investigators and calculated with Adobe Photoshop. Analysis for the total study population as well as subgroup analysis for branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO) and patients with and without macular edema (ME) was performed.

Results: For all patients, FAZ was 0.449 mm2 in FA, 0.496 mm2 in OCTA superficial capillary layer (SCL) and 3.168 in OCTA deep capillary layer (DCL). In patients without ME FAZ was 0.288 mm2 in FA, 0.342 mm2 in OCTA SCL and 1.384 mm2 in OCTA DCL. FAZ area measurement in patients with ME revealed 0.482 mm2 in FA, 0.527 mm2 in OCTA SCL and 3.554 mm2 in OCTA DCL.

Conclusions: Especially the SCL of OCTA shows a good agreement to FA in measurement of FAZ in all patients with low limits of variation in patients without ME. There were no considerable differences in BRVO and CRVO. OCTA could replace FA in FAZ area measurement in patients with RVO, especially in those without ME, achieving similar measurements whilst being non-invasive.

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Conflict of interest statement

JUW, FB, GEL, JD, GKL and CE received financial support from Carl Zeiss Meditec AG, Jena, Germany. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Patient example with CRVO.
Fundus photography of the right eye with intraretinal hemorrhages (a). FA 34 s after dye injection showing blockage of retinal and choroidal fluorescence by intraretinal hemorrhages (b). Structural OCT reveals no cystoid macular edema (c).
Fig 2
Fig 2. Prepared OCTA and FA images for evaluation of FAZ.
Same patient as shown in Fig 1. OCTA SCL with red bordered FAZ (a). Segmentation is displayed below (b). OCTA DCL with red bordered FAZ (c) with corresponding segmentation in (d). FA with red bordered FAZ (e).
Fig 3
Fig 3. FAZ: Bland-Altman-Plot for the agreement of FA and OCTA SCL for all patients.
Fig 4
Fig 4. FAZ: Bland-Altman-Plot for the agreement of FA and OCTA DCL for all patients.
Fig 5
Fig 5. FAZ: Bland-Altman-Plot for the agreement of FA and OCTA SCL in patients without ME.
Fig 6
Fig 6. FAZ: Bland-Altman-Plot for the agreement of FA and OCTA DCL in patients without ME.
Fig 7
Fig 7. FAZ: Bland-Altman-Plot for the agreement of FA and OCTA SCL in patients with ME.
Fig 8
Fig 8. FAZ: Bland-Altman-Plot for the agreement of FA and OCTA DCL in patients with ME.
See this image and copyright information in PMC

References

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