IPoster: OCT Angiography in Central Retinal Vein Occlusion

Introduction: OCT Angiography (OCTA) provides an in-vivo, non-invasive visualization of both the retinal and choroidal vasculature including segmentation of all major vascular layers. OCTA allows for valuable insight into the microvascular circulation of various retinal and choroidal disorders allowing for an in-depth analysis of pathological alterations in specific disease states including retinal vascular occlusion (RVO). 

Case Report: A 58 y/o diabetic, hypertensive male presented with complaints of decreased vision OS x 2months with light sensitivity and pain. He reported a BS of 225 but was unsure of his HBA1C. BCVA OD was 20/20 and 20/200 OS. Anterior segment exam was unremarkable. Fundoscopy revealed widespread hemorrhaging in the posterior pole, vascular tortuosity and macular edema consistent with CRVO OS. OCTA was performed and identified significant vascular changes to the DCP including widespread ischemia and capillary non-perfusion. A disturbance in macular microcirculation can be visualized on OCTA as an enlarged, asymmetric FAZ with irregularity of the surrounding vascular arcades. These findings provide insight into the causative factor behind the visual impairment associated with CRVO.

Discussion: Fluorescein Angiography (FA) has historically been used in the evaluation of RVO as it has identified abnormalities at the level of the superficial capillary plexus including enlargement of the foveal avascular zone (FAZ). However, FA does not provide segmentation into the individual vascular layers and thus is unable to visualize the deep capillary blood supply. OCTA has allowed for precise visualization of abnormalities at the deep capillary plexus (DCP) in RVO.

Conclusion(s): Depth encoded mapping via OCTA of CRVO patients has allowed for enhanced visualization of the microvascular changes occurring at the level of the DCP. These changes are directly correlated with the level of visual impairment suggesting that these changes are functionally relevant.

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