Imaging of Corneal Neovascularization: Optical Coherence Tomography Angiography and Fluorescence Angiography

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PURPOSE. The purpose of this study was to compare optical coherence tomographyangiography (OCTA) and indocyanine green angiography (ICGA) for the assessment ofcorneal neovascularization (CoNV).METHODS. Patients with CoNV extending at least 3 mm into the cornea were included. Allpatients underwent corneal imaging at the same visit. Images were recorded using theAngioVue OCTA system (Optovue, Inc.) with the long corneal adaptor module (CAM-L). ICGAimages were recorded with fluorescent filters using the Heidelberg system (HRA2 ScanningLaser Ophthalmoscope; Heidelberg Engineering). Images were graded for quality by twoindependent observers. Vessel parameters: area, number, diameter, branch and end points,and tortuosity, were compared between devices. Bland-Altman plots were used to assessdifferences between parameters.RESULTS. Fifteen patients with CoNV predominantly associated with microbial keratitis wereincluded. Mean subjective image quality score was better for ICGA (3.3 6 0.9) than for OCTA(2.1 6 1.2, P ¼ 0.002), with almost perfect interobserver agreement for ICGA images (j ¼0.83) and substantial agreement for OCTA images (j ¼ 0.69). Agreement of grading of allinvestigated vessel parameters between ICGA and OCT images was slight to moderate, withsignificant differences found for vessel diameter (�8.98 lm, P ¼ 0.01, 95% limits ofagreement [LOA]: �15.89 to �2.07), number of branch (25.93, P ¼ 0.09, 95% LOA: �4.31 to56.17), and terminal points (49, P ¼ 0.05, 95% LOA: 0.78 to 97.22).CONCLUSION. Compared with ICGA, current OCTA systems are less precise in capturing smallvessels in CoNV complexes, and validation studies are needed for OCTA segmentationsoftware. OCTA, however, complements ICGA by providing evidence of red blood cell flow,which together with depth information, may be helpful when planning treatment of CoNV.
Original languageEnglish
Pages (from-to)1263-1269
JournalInvest Ophthalmol Vis Sci.
Publication statusAccepted/In press - 8 Feb 2018


  • corneal imaging
  • cornea neovascularization
  • optical coherence tomography angiography
  • fluorescence angiography
  • indocyanine green angiography


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