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. 2023 Mar 16;18(3):e0283202.
doi: 10.1371/journal.pone.0283202. eCollection 2023.

Blood flow pattern in eye before development of type 3 macular neovascularization

Saya Yamaguchi  1 , Ichiro Maruko  1 , Ruka Maruko  1 , Taiji Hasegawa  1 , Tomohiro Iida  1
Affiliations

Blood flow pattern in eye before development of type 3 macular neovascularization

Saya Yamaguchi et al. PLoS One. .

Abstract

Purpose: To determine the blood flow pattern of eyes before the development of type 3 macular neovascularization (MNV) by optical coherence tomography angiography (OCTA).

Study design: Retrospective study.

Subjects: Ten eyes of 10 patients (4 men and 6 women, mean age 80.4 years) diagnosed with unilateral Type 3 MNV who developed type 3 MNV in the fellow normal eye during the follow-up period were studied.

Methods: The time of onset of type 3 MNV was defined as the time when retinal exudation was detected by OCT. The blood flow of a 3 x 3 mm or 6 x 6 mm area in the deep capillary plexus (DCP) and the outer retina (OR) including the central fovea were assessed at the onset and at 6 months prior to the onset of the type 3 MNV.

Results: All MNVs that developed in the fellow eye were type 3 MNVs. Abnormal blood flow signals in the MNVs were detected in the DCP and/or the OR by OCTA at the onset in all cases. Eight of the 10 eyes had OCTA recordings prior to the development of the MNV: 3 eyes had non-exudative MNVs only in the DCP and 5 eyes had non-exudative MNVs in the DCP and OR. The exudation appeared on the average 3.5 months after the non-exudative MNV was observed in the fellow eyes.

Conclusions: A non-exudative MNV in the fellow eyes can already be observed by OCTA in eyes before the onset of the exudation. Knowing this will help clinicians not only how to treat these eyes appropriately but will also help in determining the origin of the MNV.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Fluorescein angiographic (FA), Indocyanine angiographic (ICGA), and optical coherence tomographic (OCT) images at the baseline of Case 3 with a type 3 macular neovascularization (MNV) in the left eye.
Top row: FA and ICGA of the right eye (A and B) do not show any signs of an MNV. FA of left eye (C) shows leakage in the macula area. ICGA image of the left eye (D) shows hyperfluorescence corresponding to the leakage of FA. Bottom row: OCT image of the right (E) eye appears normal but the left (F) eye shows cystoid macular edema with pigment epithelial detachment (PED). The irregularities of the RPE are due to drusen.
Fig 2
Fig 2. En face optical coherence tomography angiographic (OCTA) images of the right eye 3 months prior to the onset of the exudative type 3 MNV.
Same case shown in Fig 1. A: Early en face OCTA image of the right eye showing deep capillary plexus (DCP) with abnormal blood pattern in the inferior-nasal area of the macula located at the intersection of the horizontal (green) and vertical (red) lines. B: Early en face OCTA image of the right eye showing that the outer retina (OR) region is normal. C: B scan OCTA image of the DCP segment overlayed with blood information shows abnormal blood pattern in the DCP segment. D: B scan OCTA image of the OR segment overlayed with blood information shows no abnormalities of the blood flow pattern.
Fig 3
Fig 3. OCTA and OCT B scan images of the DCP and OR segments at the onset of type 3 MNV of the fellow right eye of the same case shown in Fig 1.
A: En face OCTA image of the DCP of the right eye showing abnormal blood flow pattern in the inferior-nasal area of the macula where the horizontal green and vertical red lines cross. B: En face OCTA image of the OR segment showing blood flow pattern of the same area shown in A. C: B scan OCTA image of the DCP segment overlayed with blood information shows the abnormal blood pattern with retinal edema and PED. D: B scan OCTA image of the OR segment overlayed with blood information shows abnormal blood pattern with retinal edema and PED.
Fig 4
Fig 4. Baseline findings in Case 5 with a type 3 MNV in the left eye.
A type 3 MNV developed in the fellow normal right eye during the follow-up period. Top row: FA and ICGA of the right (A and B) show no abnormalities. FA of the left eye (C) shows leakage in the superotemporal region of the fovea. The findings in the temporal fovea could not be confirmed because of blockage by intraretinal hemorrhage. ICGA image of the left eye (D) shows hyperfluorescence as hot spots corresponding to the leakage of FA. Bottom row: OCT image of the right eye (E) has no abnormality other than RPE irregularities due to drusen. OCT image of the left eye (F) shows cystoid macular edema, PED, and intra- and sub-retinal hyperreflective tissue associated with the hemorrhages.
Fig 5
Fig 5. OCTA and OCT images at 3 months before the onset of type 3 MNV of the right eye in the same case shown in Fig 4.
A: Prior en face OCTA image of the DCP segment showing abnormal blood pattern in the superotemporal area of the macula bordered at the intersection of the horizontal (green) and vertical (red) lines. B: Prior en face OCTA image of the OR segment showing abnormal blood pattern in the superior-temporal area of the macula. C: B scan OCTA image of the right eye overlayed with blood information shows the abnormal blood pattern in the DCP segment. D: B scan OCTA image overlayed with blood information also shows the abnormal blood pattern in the OR segment.
Fig 6
Fig 6. En face OCTA and OCT images at onset of the type 3 MNV of the right eye of the same case shown in Fig 4.
A: En face OCTA image of the DCP segment shows abnormal blood pattern in the superotemporal area of the macula located at the intersection of the horizontal (green) and vertical (red) lines. B: En face OCTA image of the OR segment showing abnormal blood patterns in the superotemporal area of the macula located at the intersection of the horizontal (green) and vertical (red) lines. C: B scan OCTA image overlayed with blood information shows the abnormal blood information in the DCP segment. D: B scan OCTA image overlayed with blood information shows the abnormal blood patterns in the OR segments.
See this image and copyright information in PMC

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