OSLI Retina

November 2019

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740 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Eyelashes Artifact in Ultra-Widefield Optical Coherence Tomography Angiography Enrico Borrelli, MD, FEBO; Pasquale Viggiano, MD; Federica Evangelista, MD; Lisa Toto, MD, PhD; Rodolfo Mastropasqua, MD, FEBO BACKGROUND AND OBJECTIVE: To describe the pres- ence of eyelashes artifact in ultra-widefield swept- source optical coherence tomography angiography (SS-OCTA) images. PATIENTS AND METHODS: In this prospective, cross- sectional study, 52 healthy, young subjects were imaged with the SS-OCTA system. OCTA scans were taken in primary and extremes of gaze, and a montage was automatically created. The en face choriocapillaris images were then exported, and a semi-automated algorithm was used for subsequent quantitative analysis. RESULTS: The authors noted the presence of some linear regions of reduced brightness, which were assumed to represent a shadow effect due to pa- tient eyelashes. In order to quantify this effect, the authors performed a quantitative analysis of the superior and inferior regions in the retinal and cho- roidal vessels. CONCLUSIONS: The authors' qualitative and quan- titative analysis showed the presence of regions of false-positive hypoperfusion secondary to eye- lashes artifacts. To the authors' knowledge, this represents the first description of this new type of shadowing artifact affecting OCTA images. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:740-743.] INTRODUCTION The development of optical coherence tomogra- phy angiography (OCTA) has opened a new era in the analysis of the retinal and choroidal microvas- culature, allowing the evaluation of the individual vascular plexuses at extremely high resolution. Using OCTA, many studies have investigated these plex- uses highlighting vascular, structural, and functional alterations in healthy and pathologic eyes. 1-5 One of the main limitation of this technique is represented by the artifacts associated, which have been widely described and are known to be potential confounding factors in the vascular analysis. 1,5-9 The recent introduction of high-speed swept- source OCTA (SS-OCTA) devices has significantly expanded the assessment of the vascular plexuses. Importantly, a higher-speed system allows the acqui- sition of a larger field of view, ensuring a wider inves- tigation of the retinal and choroidal vessels. There- fore, this kind of technology grants to image from the macula to the far retinal periphery and is thus termed ultra-widefield OCTA imaging. In recent years, several imaging modalities have been developed for acquiring ultra-widefield images, including fluorescein angiography, autofluorescence, and fundus color imaging. 10 However, the very large field of view obtained with ultra-widefield imaging commonly results in the patient's eyelashes appear- ing in the image. 11-13 In this case series, we describe the presence of eyelashes artifact in ultra-widefield SS-OCTA images. This represents the first descrip- tion of this new type of shadowing artifact affecting OCTA images. From the Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy (EB, PV, FE, LT); and Bristol Eye Hospital, Bristol, UK (RM). Originally submitted January 10, 2019. Revision received February 27, 2019. Accepted for publication March 26, 2019. The authors report no relevant financial disclosures. Address correspondence to Enrico Borrelli, MD, FEBO, Va dei Vestini 31, 66100, Chieti, Italy; email: borrelli.enrico@yahoo.com. doi: 10.3928/23258160-20191031-11 ■ B R I E F R E P O R T ■

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