OCT-Angiografie bei RPE-Einrissen im Rahmen einer exsudativen AMD: morphologische Analysen der Choriokapillaris und des RPE

Zusammenfassung

Hintergrund Ein Riss des retinalen Pigmentepithels (RPE) ist eine typische Komplikation vaskularisierter Pigmentepithelabhebungen im Rahmen einer exsudativen AMD. Unter einer proaktiven intensiven Anti-VEGF-Therapie kann es zu einer funktionellen Stabilisierung oder sogar Verbesserung kommen. Durch die neue Methode der OCT-Angiografie (OCT-A) können die retinalen Gefäße dargestellt und die Perfusionsdichte quantifiziert werden. Die vorliegende Pilotstudie untersucht die Veränderungen der Choriokapillaris (CC) im Areal mit wieder zunehmender Fundusautofluoreszenz (FAF) nach der Entstehung eines RPE-Risses mittels OCT-A.

Material und Methoden Bei 6 Augen mit einem RPE-Riss wurde prospektiv initial und alle 3 Monate eine multimodale Bildgebung inklusive einer FAF (HRA2, Heidelberg Engineering, Heidelberg, Deutschland) und OCT-A (RTVue XR Avanti, SSDA-Modus, Angiovue, Optovue, Freemont, CA, USA) durchgeführt. Durch ein interaktives MATLAB-Programm (MATLAB, MathWorks, Natick, MA, USA) wurden FAF und OCT-A geometrisch überlagert. Unter Zuhilfenahme der Software Fiji (National Institutes of Health, Bethesda, MD, USA) wurde in Arealen mit zunehmender FAF die Flussdichte in der OCT-A mit Choriokapillarissegmentierung in einem Nachbeobachtungszeitraum von durchschnittlich 12 Monaten gemessen.

Ergebnisse Es konnte eine Verkleinerung des RPE-freien Areals durch Zunahme von autofluoreszenten Gewebe im Randbereich des RPE-Einrisses im Mittel von 2,94 mm² (SD 2,1 mm²; 42,1% des initialen RPE-freien Areals) beobachtet werden. Am Ende der unterschiedlichen Nachbeobachtungszeit zeigten einige Patienten im Areal mit regenerierter Autofluoreszenz eine gegenüber dem Initialbefund verringerte Flussdichte, während andere eine gleiche oder sogar vergrößerte Flussdichte aufwiesen.

Schlussfolgerung In der vorliegenden Pilotstudie wird die OCT-A zur Analyse der CC-Struktur in Arealen regenerierender FAF nach einem RPE-Einriss getestet. Mit einer externen Bildbearbeitung wurden FAF und OCT-A im Verlauf verglichen. Hiermit konnte beobachtet werden, dass scheinbar zunächst eine Regression der CC im genannten Areal eintritt, die mit längerer Nachbeobachtungszeit und Ausbildung von autofluoreszentem SHT (Subretinal hyperreflective Tissue) sich ebenso wie die FAF bis zum CC-Ausgangsbefund regeneriert.

Abstract

Background Retinal pigment epithelium (RPE) tears are a typical complication of vascular pigment epithelium detachment in age-related macular degeneration (AMD). During proactive intense anti-VEGF therapy, stabilisation or improvement of function may occur. With the new method of OCT angiography (OCT-A), retinal vessels and flow density can be quantified. This pilot study investigates changes in the choriocapillars (CC) in areas with increasing FAF in OCT following an RPE-tear.

Methods In six eyes with an RPE-tear, prospectively initially and every three months thereafter, multimodal imaging was performed, including fundus autofluorescence (FAF) (HRA2, Heidelberg Engineering, Heidelberg, Deutschland) and OCT-A (RTVue XR Avanti, SSDA-Modus, Angiovue, Optovue, Freemont, CA, USA). With interactive MATLAB-software (MATLAB, MathWorks, Natick, MA, USA), FAF and OCT were geometrically superimposed. With the help of the Fiji software (National Institutes of Health, Bethesda, MD, USA), areas with increasing FAF flow intensity in OCT-A with CC-segmentation were measured during an average follow-up period of 12 months.

Results We measured a reduction in the RPE-free area – due to an increase in autofluorescence tissue – of an average of 2.94 mm² (SD 2.1 mm²; 42.1% of initial RPE-free area) in the boundary area of RPE-tears. At the end of the different follow-ups, some patients exhibited lower flow density in areas of regenerated autofluorescence than the initial findings. On the other hand, in some follow-ups, the same or increased flow density was seen.

Conclusion In this pilot study, OCT-A was tested to analyse the structure of CC in areas of regenerated FAF after RPE-tears. Using external image editing software, FAF and OCT-A were compared during the follow-up. Thus apparent initial regression of the CC in the area mentioned above could be observed. During the follow-up and development of autofluorescent SHT, CC also regenerates up to the level of the initial findings of CC.

Schlüsselwörter

Chorioidea - AMD - vaskularisierte Pigmentepithelabhebung - RPE-Riss

Key words

choroid - AMD - vascularized pigment epithelium detachment - RPE-tear

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