Cataract significantly influences quantitative measurements on swept-source optical coherence tomography angiography imaging

Siqing Yu, Beatrice E Frueh, Dagmar Steinmair, Andreas Ebneter, Sebastian Wolf, Martin S Zinkernagel, Marion R Munk, Siqing Yu, Beatrice E Frueh, Dagmar Steinmair, Andreas Ebneter, Sebastian Wolf, Martin S Zinkernagel, Marion R Munk

Abstract

Purpose: To analyze retinal blood flow before and after cataract surgery using swept-source optical coherence tomography angiography (SS-OCTA).

Methods: Prospective observational study. Consecutive patients were recruited and scanned using SS-OCTA before and after cataract surgery. Laser flare photometry were performed post-surgery. Perfusion and vessel density of superficial (SCP) and deep capillary plexuses (DCP) of the 3 × 3 mm images as well as foveal avascular zone (FAZ) measurements were assessed. Vessel continuity, vessel visibility and presence of artefacts were evaluated by two blinded graders using a predefined grading protocol.

Results: Thirteen eyes of 12 patients met the inclusion criteria. There was a significant increase of perfusion and vessel densities in both the SCP and the DCP after cataract surgery within the 3 × 3 mm images. Significantly better distinguishability of FAZ border was observed postoperatively in both SCP and DCP, however, FAZ area and perimeter measurements did not significantly change after cataract surgery. Mean number of motion artifacts in SCP and DCP numerically decreased by 37% (P = .089) and 42% (P = .080).

Conclusions: Lens opacities have a significant influence on retinal blood flow measurements in SS-OCTA and should be considered in quantitative vessel analysis. Inflammation may also impact the assessment of density parameters. FAZ measurements seems to be the most robust parameters in terms of media opacity.

Conflict of interest statement

The authors have declared that no competing interests exist. Marion R. Munk received lecturer fees from Novartis (Novartis AG) and travel support from Bayer (Bayer AG) and is a consultant for Allergan, Lumithera and Zeiss. Andreas Ebneter received lecturer fees and travel support from Bayer AG, grant and educational support from Novartis and is a consultant for Allergan. Sebastian Wolf is consultant for Bayer, Novartis, zeiss and heidelberg and Martin S. Zinkernagel is consultant for Novartis and Bayer AG and stockholder of Novarti AG. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Representative example of pre and…
Fig 1. Representative example of pre and post cataract surgery outlining the improved vessel continuity and visibility and the reduction in artefacts after cataract surgery.
A 79-year-old male cataract patient. In the DCP (A-F), 4 motion artefacts (black arrow) and one projection artefact (white arrow head) were found prior surgery (A). Perfusion density (B) and vessel density (C) were quantitatively measured. After surgery, same amount of artefacts were detected in the en-face image (D). Perfusion density (E) and vessel density (F) apparently increased. Scores of FAZ distinguishability and vessel continuity improved as well. In the SCP (G-L), 2 motion artefacts and one projection artefact were noticed before surgery (G). Severe motion artefacts disrupting the vessel continuity of the larger vessels. Perfusion density (H) and vessel density (I) were higher than in the DCP. After the surgery, 3 mild motion artefacts and no projection artefact were noticed (J). Perfusion density (K) and vessel density (L) apparently increased. FAZ was very well-defined. Scoring results (number of artefacts) are presented in the Table 6.

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