Conjunctival and Intrascleral Vasculatures Assessed Using Anterior Segment Optical Coherence Tomography Angiography in Normal Eyes

Akagi, Tadamichi; Uji, Akihito; Huang, Alex S.; Weinreb, Robert N.; Yamada, Tatsuya; Miyata, Manabu; Kameda, Takuro; Ikeda, Hanako Ohashi; Tsujikawa, Akitaka

doi:10.1016/j.ajo.2018.08.009

Cited by 92 publications

(100 citation statements)

References 43 publications

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“…However, using OCTA and incorporating quantitative assessment for the graft reperfusion after CAG transplantation, at different depths, has not been reported, especially in longitudinal study design as in this present study. Unlike the previous OCTA study on normal conjunctiva, 18 in which the border between the conjunctival and scleral tissues could not be delineated, the visible CAG margin in the present study provided us clear information for the depth sectioning at the CAG level or underlying episcleral level. Understanding the structure and vascularization of pterygium and the graft reperfusion after surgery helps to evaluate the risks for recurrence 19 and graft health.…”

Section: Discussionmentioning

confidence: 62%

“…1 Our group has previously demonstrated the use of OCTA to evaluate the fibrovascular structure in pterygium. 8 Similarly, Akagi and associates 18 presented the feasibility of imaging conjunctival vasculature using swept-source OCTA in 10 normal participants in a cross-sectional study. However, using OCTA and incorporating quantitative assessment for the graft reperfusion after CAG transplantation, at different depths, has not been reported, especially in longitudinal study design as in this present study.…”

Section: Discussionmentioning

confidence: 99%

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Optical Coherence Tomography Angiography for Evaluation of Reperfusion After Pterygium Surgery

Liu

Devarajan

Tan

et al. 2019

American Journal of Ophthalmology

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PURPOSE: To describe the use of optical coherence tomography angiography (OCTA) to quantitatively monitor the conjunctival graft revascularization after pterygium excision and conjunctival autograft (CAG) transplantation.DESIGN: Prospective, interventional case series. METHODS: Ten patients undergoing pterygium excision and femtosecond laser-assisted CAG transplantation were included. OCTA was performed at 1 week, 1 and 3 months postoperatively at the CAG transplantation site and harvested area. The vessel density at three different depths: conjunctival epithelium or CAG epithelium, conjunctival stroma or CAG stroma, and episclera, was evaluated and quantified. The revascularization rate was assessed and correlated with the postoperative CAG thickness. RESULTS: No intraoperative and postoperative complications occurred. Reperfusion of the CAGs was observed at 1 week, and early reperfusion within the first month accounted for more than half of graft revascularization. The vessel regrowth density was 9.6±2.6 % and 11.1±2.8 % between 1 week and 1 month, and was 9.8±1.8 % and 11.9±1.9 % between 1 and 3 months, at the CAG and underlying episcleral levels, respectively. All the CAGs were well-perfused at 3 months. The vessel regrowth density was significantly and strongly correlated with the changes of CAG thickness in a negative relationship (g [ -0.94, P [ 0.019). At the harvested site, the vascular network of episclera was not affected, and the conjunctival vascularization was restored at 1 month. CONCLUSIONS: OCTA is a promising tool to evaluate the vascularization or revascularization of conjunctiva, conjunctival graft and episclera, in a quantitative and serial manner, helping in diseases diagnosis and treatment monitoring. The graft revascularization rate was predictive of postoperative graft deswelling.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Angiography for Evaluation of Reperfusion After Pterygium Surgery

Liu

Devarajan

Tan

et al. 2019

American Journal of Ophthalmology

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“…The number of eyes had to be limited in this explorative study due to the intense computational requirements to process several terabytes of data in millions of confocal images. Canalogram studies of human eyes suggested a perilimbal, proximal vessel network with a density [15] similar to that of porcine eyes [16][17][18][19] . We hypothesized that an RSCM analysis of the lectin-labeled outflow tract of human eyes would match our findings in porcine eyes.…”

Section: Introductionmentioning

confidence: 82%

“…These results indicate that human eyes not only have far fewer collector channels but that their anatomy differs fundamentally by spanning several clock hours and having a 50% greater CSA. This came as a surprise because recent lower resolution canalogram studies of perilimbal outflow structures suggested a density and function of outflow vessels in human eyes [15] similar to that in porcine eyes [16][17][18][19] . The smaller number, longer course, and flatter, collapsible nature of CCs in human eyes may increase the risk of outflow failure and IOP elevation in glaucoma.…”

Section: Discussionmentioning

confidence: 99%

3D-Reconstruction of the Human Conventional Outflow System by Ribbon Scanning Confocal Microscopy

Loewen

Waxman

Wang

et al. 2020

Preprint

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PurposeRisk for glaucoma is driven by the microanatomy and function of the anterior segment. We performed a computation-intense, high-resolution, full-thickness ribbon-scanning confocal microscopy (RSCM) of the outflow tract of two human eyes. We hypothesized this would reveal important species differences when compared to existing data of porcine eyes, an animal that does not spontaneously develop glaucoma.MethodsAfter perfusing two human octogenarian eyes with lectin-fluorophore conjugate and optical clearance with benzyl alcohol benzyl benzoate (BABB), anterior segments were scanned by RSCM and reconstructed in 3D for whole-specimen rendering. Morphometric analyses of the outflow tract were performed for the trabecular meshwork (TM), limbal, and perilimbal outflow structures and compared to existing porcine data.ResultsRSCM provided high-resolution data for IMARIS-based surface reconstruction of outflow tract structures in 3D. Different from porcine eyes with an abundance of highly interconnected, narrow, and short collector channels (CCs), human eyes demonstrated fewer CCs which had a 1.5x greater cross-sectional area (CSA) and 2.6x greater length. Proximal CC openings at the level of Schlemm’s canal (SC) had a 1.3x larger CSA than distal openings into the scleral vascular plexus (SVP). CCs were 10.2x smaller in volume than the receiving SVP vessels. Axenfeld loops, projections of the long ciliary nerve, were also visualized.ConclusionIn this high-resolution, volumetric RSCM analysis, human eyes had far fewer outflow tract vessels than porcine eyes. Human CCs spanned several clock-hours and were larger than in porcine eyes. These species differences may point to factors downstream of the TM that increase our vulnerability to glaucoma.Grant informationNational Eye Institute K08EY022737 (NAL); Initiative to Cure Glaucoma of the Eye and Ear Foundation of Pittsburgh (NAL); Wiegand Fellowship of the Eye and Ear Foundation of Pittsburgh (YD); P30-EY08098 (NAL); Department grant by Research to Prevent Blindness (NAL); an unrestricted fellowship grant from the Xiangya Hospital of Central South University (SC).

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“…23 Small series have demonstrated proof-of-principle in iridal, corneal and conjunctival tissue. [24][25][26] Most commercially-available OCTA devices do not support the full range of image acquisition and analysis modes for the anterior segment that were developed for retinal images, however, and obtaining good image quality can therefore be challenging. 27 Using OCTA of the anterior segment, Skalet et al demonstrated vascular patterns in pigmented lesions of the iris and found a difference in vascular density between three iris nevi and three iris melanomas.…”

Section: Introductionmentioning

confidence: 99%

Anterior Segment OCTA of Melanocytic Lesions of the Conjunctiva and Iris

Brouwer

Marinković

Bleeker

et al. 2021

American Journal of Ophthalmology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Conjunctival and Intrascleral Vasculatures Assessed Using Anterior Segment Optical Coherence Tomography Angiography in Normal Eyes

Abstract: OCTA is a promising tool for evaluating conjunctival and intrascleral vasculatures. It may also help in understanding ocular surface blood flow relevant to vascular and ocular surface diseases, as well as aqueous humor outflow.

Cited by 92 publications

References 43 publications

Optical Coherence Tomography Angiography for Evaluation of Reperfusion After Pterygium Surgery

Optical Coherence Tomography Angiography for Evaluation of Reperfusion After Pterygium Surgery

3D-Reconstruction of the Human Conventional Outflow System by Ribbon Scanning Confocal Microscopy

Anterior Segment OCTA of Melanocytic Lesions of the Conjunctiva and Iris

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